Influence of Etching Protocol and Silane Treatment with a Universal Adhesive on Lithium Disilicate Bond Strength

Effect of filler contents on the bond strength of CAD/CAM resin crowns: New resin primer versus conventional silane agents

Purpose This study aims to evaluate the effects of resin primers containing methyl methacrylate (MMA) and silane agent on the bonding effectiveness of indirect resin composite blocks with three different filler contents.Methods A commercially available computer-aided design/computer-aided manufacturing (CAD/CAM) resin composite block and two experimental resin composite blocks with different filler contents were alumina-blasted and two surface treatments (primer and silane agent) were applied. The resin cement was built up, and the micro-tensile bond strength (μTBS) was measured after 24 hours, 1 month or 3 months of water storage (n = 24 per group). The fracture surfaces after μTBS measurements and resin block/cement interface were observed by scanning electron microscopy (SEM).Results The primer treatment group showed a significantly higher bond strength than the silane group only in F0 (filler content 0 wt%) group (P < 0.001). In the primer group, F0 and F41 (filler content 41 wt%) groups showed significantly higher bond strengths than F82 (filler content 82 wt%) group (P < 0.001). In contrast, in the silane group, F41 group showed significantly higher bond strength than F0 and F82 groups (P < 0.001), and F82 group showed significantly higher bond strength than F0 group (P < 0.001). SEM revealed that the matrix resin was partially destroyed on the fracture surface of the primer group, and an uneven interface surface was observed compared with that of the silane group.Conclusions MMA-containing primers showed higher bonding effectiveness to CAD/CAM resin composite blocks than the silane treatment.

Effect of the difference water amounts and hydrolysis times of silane coupling agent on the shear bond strength between lithium disilicate glass ceramic and composite resin

This study was to evaluate the effect of different water amounts and hydrolysis times of silane coupling agent on shear bond strength between lithium disilicate glass ceramic (LDS) and composite resin. Fourteen groups (n=7) of different water amounts (90, 50 and 10%v/v) and hydrolysis times (5, 19, 75 and 300 s) of experimental silane coupling agent that were prepared for silanization, non-silanization and commercial silane coupling agent (CSC) groups. Two-way analysis of variance (ANOVA) revealed no interaction between water amounts and hydrolysis times of ESC on shear bond strength between LDS and composite resin. One-way ANOVA exhibited the highest shear bond strength and the highest mean percentage in mixed failure mode in the 50%v/v group. Molecular analysis of 13C and 29Si indicated that nuclear magnetic resonance spectra of M2 and M3 hydrolysis species were found in 50%v/v group. The presenting of M2 and M3 which was predominant factor contributing to the highest shear bond strength.

Can a Self-etching Primer be Effective in Bonding Aligner Attachments to Different Types of Ceramics?

Objective

This in vitro study aimed to evaluate the effectiveness of pretreatment with a self-etching primer for bonding aligner attachments to lithium disilicate (LD) and monolithic zirconia (MZ) ceramics.

Methods

Forty ceramics, including LD (n=20) and MZ (n=20), were divided into four study groups according to the surface pretreatments: LD specimens pretreated with universal primer (Monobond Plus, MP) after hydrofluoric acid etching (Group 1); MZ ceramics pretreated with MP after sandblasting (Group 2); LD ceramics pretreated with self-etching ceramic primer (Monobond etch & prime, MEP) (Group 3); and MZ ceramics pretreated with MEP after sandblasting (Group 4). The aligner composite (GC Aligner Connect) and universal adhesive (GPremio Bond) were used to prepare the resin attachments. The bond strength was evaluated by micro-shear bond strength (SBS) testing (0.1 mm/min) after thermocycling, and the remnant adhesive was scored according to the resin attachment remnant index (RARI). The SBS data were analyzed using ANOVA and Tukey tests, and the RARI scores were analyzed using the chi-square test.

Results

Group 1 had the lowest SBS, and group 2 had the highest SBS. There were significant differences between the groups in terms of bond strength (p<0.05). The RARI scores showed no significant differences, regardless of the pretreatment and ceramic type.

Conclusion

The use of a self-etching primer increased the bond strength of resin attachments on LD ceramics. For zirconia ceramics, both ceramic primers are recommended for aligner attachment bonding.

Semidirect Resin Composite Veneers in a Patient with Bruxism

This case report details the esthetic rehabilitation of a 32-year-old male patient suffering from sleep bruxism, primarily manifesting as a fracture and significant loss of tooth structure in the anterior maxillary central incisors. To address these concerns, the patient underwent a restorative treatment involving the application of semidirect resin composite veneers on the maxillary incisors and direct resin composite restoration on the incisal regions of the maxillary canines. This approach not only restored the functional integrity of the teeth but also significantly enhanced the patient's esthetic appearance.

Effect of universal adhesives and self-etch ceramic primers on bond strength to glass-ceramics: A systematic review and meta-analysis of in vitro studies

STATEMENT OF PROBLEM

To simplify dental procedures, multicomponent products such as universal adhesives and self-etch ceramic primers have been recommended for glass-ceramic bonding; however, studies have shown a wide range of results.

PURPOSE

The purpose of this systematic review and meta-analysis was to analyze the in vitro bond strength promoted by hydrofluoric acid+silane-containing universal adhesives and a self-etch ceramic primer to glass-ceramics and compare it with that of conventional treatments.

MATERIAL AND METHODS

A systematic search was conducted in the PubMed/Medline, Scopus, LILACS, and ISI Web of Science databases up to April 2021. In vitro studies assessing the resin-mediated bond to glass-ceramics by using a self-etch ceramic primer and hydrofluoric acid+silane-containing universal adhesives and/or compared with traditional hydrofluoric acid+glass-ceramic primers were included. Selection of studies, data extraction, and risk-of-bias analysis were performed. Statistical analysis was performed by using a review management software program using a random effects model (α=.05).

RESULTS

A total of 33 studies were included in the qualitative analysis and 26 studies in the quantitative analysis. Bond strength to lithium disilicate ceramic was higher when a hydrofluoric acid+glass-ceramic primer was used than when using a hydrofluoric acid+silane-containing universal adhesive (P<.05), except when 9% to 10% acid concentration was used in combination with static aging (P=.100). A self-etch ceramic primer promoted bond strength values to lithium disilicate that were similar to those of the hydrofluoric acid+glass-ceramic primer (P>.100).

CONCLUSIONS

Hydrofluoric acid+silane-containing universal adhesive was not as effective as the hydrofluoric acid+glass-ceramic primer in promoting bond strength to glass-ceramic. Bond strength values generated by a self-etch ceramic primer to glass-ceramic were similar to those generated by the conventional treatment.

Effect of Combined Application of Hydrofluoric and Phosphoric Acids and Active Irrigation with a Microbrush on Shear Bond Strength of Lithium Disilicate Ceramics to Enamel

Background

This study assessed the effect of combined application of hydrofluoric (HF) acid and phosphoric acid (PA) and active irrigation (AI) with a microbrush on shear bond strength (SBS) of lithium disilicate (LDS) ceramics to enamel.

Materials and Methods

This in vitro study was conducted on 40 extracted teeth that received enamel preparation with a #12 cylindrical bur. Forty IPS e.max LT rods (3mm diameter, 6mm height) were fabricated and randomly assigned to four groups (n = 10) for surface treatment with 5% HF (group 1), 5% HF and AI with a microbrush for 20 seconds (group 2), 5% HF and 32% PA (group 3), and 5% HF and 32% PA plus AI with a microbrush for 20 seconds (group 4). Silane and Choice 2 cement were used for bonding rods to enamel. The SBS was measured by a universal testing machine. Data were analyzed by two-way analysis of variance (ANOVA), Bonferroni, and Chi-square tests (alpha = 0.05).

Results

Group 4 had the highest SBS, and group 1 had the lowest SBS (P < 0.05). Group 2 had a significantly higher SBS than group 1, and group 4 had a significantly higher SBS than group 3. AI with a microbrush significantly increased the SBS (P < 0.05), but the application of PA caused no significant change in SBS (P > 0.05). The interaction effect of PA and AI on SBS was not significant (P > 0.05).

Conclusion

The application of PA in addition to 5% HF acid caused no significant change in the SBS of LDS ceramic to enamel. However, AI with a microbrush significantly increased the SBS.

Interfacial fracture toughness of different surface treatments on zirconia-reinforced lithium silicate glass-ceramics

This study investigated the influence of different surface treatments on unfiring or firing zirconia-reinforced lithium silicate (ZLS) glass-ceramics. Celtra Duo and IPS e.max CAD blocks were cut and process following manufacturer protocols. The specimen surface was treated with seven different protocols. Two ceramic blocks with the same surface treatment were bonded with luting agent and prepared for mini-interfacial fracture toughness tests (mini-iFT). The specimens were tested after 1-week storage. The data was statistically analyzed using two-way ANOVA and Dunnett's T3 comparison (α=0.05). The highest mini-iFT of both Celtra Duo unfired and fired was shown in the HF+S group, which was not significantly different from HF+S+UA. For IPS e.max CAD, the mini-iFT was higher in the groups treated with hydrofluoric acid. Additional adhesive after silane application did not significantly improve bonding effectiveness. Therefore, surface treatment with hydrofluoric acid and silane is recommended for both unfiring and firing ZLS glass ceramics.

Bonding stability of universal adhesives to feldspathic ceramic with or without prior silane application

PURPOSE

This study aimed to assess the bonding stability of three universal adhesives to a CAD-CAM feldspathic ceramic with or without prior silane application.

MATERIALS AND METHODS

The universal adhesives tested were Ambar Universal (FGM), Single Bond Universal (3M), and Ybond Universal (Yller). Scotchbond Multipurpose Plus (3M) was used as a control. The silane used was RelyX Ceramic Primer (3M). Microtensile bond strength (μTBS) to Vitablocs Mark II was measured after 24 h or 6 months of water aging (n = 20). Failure modes were observed through scanning electron microscopy, and pH and degree of C=C conversion (DC) of the adhesives were measured (n = 3). Data were analyzed using one-, two-, and three-way ANOVA.

RESULTS

The pH values differed significantly among the adhesives (p < 0.001), while the DC was similar (p = 0.141). The universal adhesives showed significant differences in μTBS, with higher immediate results when using silane and lower results after aging. Notably, a significant decrease in μTBS was observed after 6 months when silane was applied. In contrast, the control adhesive exhibited consistent results between the 24-h and 6-month storage periods. The universal adhesives showed a decrease in μTBS ranging from 25.5% to 40.1% after prolonged storage. Adhesive failures were predominant in all groups. The presence or absence of silane in the adhesive composition did not affect the bonding performance.

CONCLUSIONS

The application of a separate silane coupling agent improved the immediate bond strength of universal adhesives to CAD-CAM feldspathic ceramic. However, this bond strength significantly decreased after 6 months of water aging. The bond strength remained stable for universal adhesives when applied without silane after 6 months of aging.

The Classification and Selection of Adhesive Agents; an Overview for the General Dentist

Adhesive agents are essential to most restorative procedures used in everyday practice. Depending on the clinical situation, the dentist will choose among a rapidly evolving variety of adhesive agents (bonding agents). Due to the availability of many adhesive agents, appropriate selection can take time and effort. Typically, a practitioner relies more on marketing and experience than in-depth material knowledge. The classification of adhesive agents may need to be clarified and easier to remember due to its lack of relevance to clinical procedures. This paper reviews the published literature retrieved from PubMed, Google Scholar, and Scopus by using specific keywords "adhesive agents", "classification", "dentin", "enamel", "universal", "self-etch", "etch-and-rinse", and "bonding". The titles and abstracts were screened, and the relevant literature was retrieved. The list of references from each identified article was examined to find other potentially relevant articles. Adhesive agents can be classified as etch-and-rinse, self-etch, or "multi-mode" according to their approach to interacting with the smear layer, and each approach can be further classified according to the number of clinical steps required during application. This article reviews the classification of current adhesive agents and discusses the properties that make a specific adhesive agent the optimal choice for a particular clinical indication. The review will assist the general dentist in understanding the various types of available adhesive agents and how they function. Overall, the review will facilitate decision-making and allow the selection of appropriate materials.

Effects of Different Primers on the Bond Strength to Properly and Excessively Etched Ceramic-coated Zirconia

PURPOSE

To determine the effects of various primers on the immediate and long-term bond strength of ceramic-coated ultratranslucent zirconia that is properly or excessively etched.

METHODS AND MATERIALS

Ceramic-coated zirconia plates were etched with 9.5% hydrofluoric acid (HF) for 2 or 5 minutes, after which the surface morphology and elemental composition were examined. The etched specimens were treated with different primers including methacryloyloxydecyl dihydrogen phosphate (MDP)-only containing primer, silane-only containing primer, MDP and silane-containing ceramic primer as well as MDP and silane-containing adhesive system. For surface contact angle and shear bond strength (SBS) data, the difference between groups was evaluated by one-way analysis of variance (ANOVA) and three-way ANOVA factorial analysis, respectively. The statistical significance level of 0.05 was set and the Tukey test and the Dunnett-T3 test were used for post-hoc multiple comparisons.

RESULTS

Excessive etching (9.5% HF for 5 minutes) led to overconsumption of the glass layer and exposure of zirconia substrate compared to proper etching (9.5% HF for 2 minutes). Among different primers, the surface contact angle of the silane-only containing primer group was the lowest. The silane-only containing primer and MDP and silane-containing ceramic primer produced higher shear bond strength of properly and excessively etched ceramic-coated zirconia, respectively, both before and after thermal aging.

CONCLUSIONS

The silane-only containing primer and MDP and silane-containing primer can obtain better immediate and long-term shear bond strength for properly and excessively etched ceramic-coated zirconia, respectively.

Argon Plasma Treatment Effects on the Micro-Shear Bond Strength of Lithium Disilicate with Dental Resin Cements

The low bond strength of lithium disilicate (LD) ceramics to dental resin cements remains a critical issue for dental applications because it leads to frequent replacement and causes tooth tissue destruction and consumption. The objective of this study was to examine the effects of atmospheric non-thermal argon plasma (NTP) treatment on LD to improve its micro-shear bond strength (μSBS) with dental resin cements because LD mostly experiences shear stress for its commonly used dental applications as crowns or veneers. Argon plasma treatment was performed on hydrofluoric (HF) acid-etched LD surfaces, and then commercial resin cements were subsequently applied to the treated LD surfaces. The plasma treatment significantly reduced the water contact angle of the LD surface to less than 10° without changing the surface morphology. The μSBS test was performed with cement-bonded LD samples after 24 h and 30 days, as well as after 1000 cycles of thermal cycling. The test results show that, as compared with the untreated controls, 300 s of plasma treatment significantly improved the LD-resin cement bond strength by 59.1%. After 30 days of storage in DI water and 1000 cycles of thermal cycling, the plasma-treated LD samples show 84.2% and 44.8% higher bond strengths as compared to the control samples, respectively. The plasma treatment effect on LD surfaces diminished rapidly as the bond strength decreased to 25.5 MPa after aging in the air for 1 day prior to primer and cement application, suggesting that primers should be applied to the LD surfaces immediately after the plasma treatment. These results demonstrate that, when applied with caution, plasma treatment can activate LD surfaces and significantly improve the SBS of LD with dental resin cements in both short-term and long-term periods.

Chemical Surface Modification Methods of Resin Composite Repaired with Resin-Modified Glass-Ionomer Cement

OBJECTIVE

 This study examined the chemical surface modification methods of resin composite repaired with resin-modified glass-ionomer cement (RMGIC).

MATERIALS AND METHODS

 Ninety aged resin composite rods were produced and sorted into 9 groups of 10 specimens and surface modified with silane agent and/or bonding agent as follows: group 1, no surface modified; group 2, etch + single bond 2 (SB2); group 3, SB2; group 4, etch + RelyX ceramic primer (RXP) + SB2; group 5, RXP + SB2; group 6, etch + single bond universal (SU); group 7, SU; group 8, etch + RXP + SU; and group 9, RXP + SU. A clear silicone mold was placed on the top of specimen center, and then filled with RMGIC. The specimens' shear bond strengths (SBSs) were examined in mechanical testing equipment. To determine failure types, the fractured specimen surfaces were inspected using a stereomicroscope.

STATISTICAL ANALYSIS

 The data collected were analyzed using one-way analysis of variance, and significance level was operated using Tukey's test (p < 0.05).

RESULTS

 Group 8 had the greatest SBS, but it was statistically indistinguishable from groups 4, 5, and 9. The most frequent fracture mode was adhesive failure. High SBS was commonly associated with mixed failure.

CONCLUSION

 The use of bonding agents enhances the resin composite's wettability and allows it to bond to RMGIC. Moreover, the use of the silane coupling agent before applying bonding agent showed significantly higher bonding ability of resin composite and RMGIC interface.

Effect of plasma surface treatment of three different CAD/CAM materials on the micro shear bond strength with resin cement (A comparative in vitro study)

Objectives

This study aimed to evaluate and compare the effect of plasma treatment versus conventional treatment on the micro shear bond strength (μSBS), surface roughness, and wettability of three different CAD/CAM materials.

Materials and methods

Sixty cylindrical specimens (5 mm diameter × 3 mm height) were prepared from three different CAD/CAM materials: Group A: Zirconia, Group B: Lithium disilicate, and Group C: Resin nano-ceramic. Each group was subdivided into two subgroups according to surface treatment used: Subgroup I: Conventional treatment, zirconia was sandblasted with Al₂O₃, while lithium disilicate and resin nano-ceramic were etched with hydrofluoric acid. Subgroup II: Plasma treatment, the surface of each material was treated with a plasma device (PiezoBrush® PZ3 Handheld Device, Relyon Plasma, Regensburg, Germany). G-Multi PRIMER was applied, then self-adhesive cement (G-CEM ONE) was applied using a split mold (1 mm diameter × 3 mm height), and μSBS was tested in a universal testing machine. The surface roughness was measured using a profilometer. Nine additional specimens of each material for wettability test using an optical tensiometer.

Statistical analysis

The data were analyzed using ANOVA and Bonferroni test at a level of significance of 0.05.

Results

The highest mean of μSBS was recorded by AII (27.3 MPa), while the lowest was recorded by AI (17.9 MPa). One-way ANOVA test revealed a significant difference among groups. Bonferroni test showed each two subgroups significant difference except subgroups AI, CI and BII, CII, where there was a non-significant difference. For all CAD/CAM materials, conventional treatment increased the surface roughness compared to plasma treatment, while the contact angle decreased after plasma treatment.

Conclusion

Plasma treatment increased the μSBS of resin cement to zirconia significantly while not significantly affecting the μSBS of resin nano-ceramic. Conventional treatment of lithium disilicate provided significantly higher μSBS than plasma treatment.

Decontamination of lithium disilicate ceramics using various photosensitizers, herbal and chemical disinfectants, and the effect of surface conditioners on bond strength values

AIM

To assess and compare the antimicrobial efficacy of disinfectants on lithium disilicate ceramic (LDC) used in dental applications and shear bond strength (SBS) of LDC after using different conditioners hydrofluoric acid (HF), self-etching ceramic primers (SECP) and Neodymium-doped yttrium orthovanadate (Nd: YVO4).

MATERIALS AND METHODS

One hundred and twenty LDC discs were fabricated by auto-polymerizing acrylic resin using the lost wax technique. S. aureus, S. mutans, and C. albican were inoculated on thirty discs (n=30 each). Each group was further divided into three subgroups based on different disinfecting agents used (n=30) Group 1: Garlic extract, Group 2: Rose Bengal (RB) activated by PDT, and Group 3: Sodium hypochlorite (NaOCl). An assessment of the survival rate of microorganisms was performed. The remaining thirty samples were surface treated using three different LDC surface conditioners (n=10) Group 1: HF + Silane (S), group 2: SECP, and Group 3: Nd: YVO4 laser+S. SBS and failure mode analysis were performed using a universal testing machine and stereomicroscope at 40x magnification, The statistical analysis was conducted using one-way ANOVA and Post Hoc Tukey test.

RESULTS

Garlic extract, RB, and 2% NaOCl sample displayed comparable outcomes of antimicrobial potency against C. albicans, S aureus, and S. mutans (p>0.05). Furthermore, SBS analysis showed HF+S, SECP, and Nd: YVO4+S exhibited comparable outcomes of bond strength (p>0.05).

CONCLUSION

Garlic extract and Rose bengal activated by PDT can be contemplated as alternatives to the chemical agent NaOCl used for LDC disinfection. Similarly, SECP and Nd: YVO4 possess the potential to be used for the surface conditioning of LDC to improve the bond integrity with resin cement.

Ceramic Bonding Interface under Shear-Compression Stress: Ultra-High-Speed Imaging Contribution

The aim of this study is to visualize and characterize by ultra-high-speed imaging (UHSI) the failure phenomena at the resin-ceramic bonding interface of lithium disilicate (LiSi2) samples bonded with gold-standard protocol (Monobond Plus [MB]) and the nontoxic one (Monobond Etch & Prime [MEP]) subjected to mechanical loading. Unprecedented frame rate, image resolution, and recording time were reached by using the most advanced UHSI camera. The finite element analysis (FEA) of the proposed mechanical test confirmed that the specific design of our samples enables a combined shear and compression stress state, prone to test the bonding interface while being close to physiological stresses. Ten LiSi2 samples were pretreated by gold standard (MB, n = 5) and self-etching primer (MEP, n = 5). Axial compression loading gradually increased until catastrophic failure was performed. As shown by the FEA, the angle between the bonding interface and load direction leads to shear-compression stresses at the resin-ceramic bonding interface. Failure was recorded by UHSI at 300,000 fps. All recorded images were analyzed to segregate events and isolate the origin of fracture. For the first time, thanks to the image recording setup, it was observed that debonding is the first event before breakage, highlighting that sample fracture occurs by interfacial rupture followed by slippage and cohesive failure of materials. Failure mode could be described as mixed. MEP and MB showed similar results and behavior.

Impact of in vitro findings on clinical protocols for the adhesion of CAD-CAM blocks: A systematic integrative review and meta-analysis

STATEMENT OF PROBLEM

Computer-aided design and computer-aided manufacturing (CAD-CAM) blocks have evolved rapidly, making it difficult to establish the best clinical protocol for bonding a given block and whether an established protocol is appropriate for a newly introduced product.

PURPOSE

This integrative systematic review and meta-analysis aimed to clarify whether the clinician can select the most efficient adhesion protocols for CAD-CAM blocks by reading published in vitro studies and implementing them in daily practice.

MATERIAL AND METHODS

Based on the population, intervention, comparison, and outcome (PICO) strategy, 3 databases were searched for in vitro studies, randomized clinical trials, prospective or retrospective studies, and case reports from January 1, 2015, to July 31, 2021. A meta-analysis analyzed 28 studies to calculate the mean difference between best and worst protocols for each author and block with a random-effects model (α=.05).

RESULTS

From 508 relevant studies, 37 in vitro studies, 2 clinical studies, and 1 clinical report were selected for data extraction and qualitative analysis. Vita Enamic, IPS e.max CAD, LAVA Ultimate, and Vita Mark II blocks were the most studied, and RelyX Ultimate was the most used luting cement. The meta-analysis confirmed the null hypothesis that the evidence-based efficacy of clinical protocols to bond CAD-CAM blocks is still controversial (P<.05).

CONCLUSIONS

There are objective standards for individual in vitro tests, but the studies lack standardization. Some tested protocols were more efficient than others. Randomized clinical trials and well-documented clinical situations were almost nonexistent, making direct application of in vitro findings in clinical practice impossible.

Phase Formation, Mechanical Strength, and Bioactive Properties of Lithium Disilicate Glass-Ceramics with Different Al2O3 Contents

Owing to its excellent mechanical properties and aesthetic tooth-like appearance, lithium disilicate glass-ceramic is more attractive as a crown for dental restorations. In this study, lithium disilicate glass-ceramics were prepared from SiO₂-Li₂O-K₂O-P₂O₅-CeO₂ glass systems with various Al₂O₃ contents. The mixed glass was then heat-treated at 600 °C and 800 °C for 2 h to form glass-ceramic samples. Phase formation, microstructure, mechanical properties and bioactivity were investigated. The phase formation analysis confirmed the presence of Li₂Si₂O₅ in all the samples. The glass-ceramic sample with an Al₂O₃ content of 1 wt% showed rod-like Li₂Si₂O₅ crystals that could contribute to the delay in crack propagation and demonstrated the highest mechanical properties. Surface treatment with hydrofluoric acid followed by a silane-coupling agent provided the highest micro-shear bond strength for all ceramic conditions, with no significant difference between ceramic samples. The biocompatibility tests of the material showed that Al₂O₃-added lithium disilicate glass-ceramic sample was bioactive, thus activating protein production and stimulating the alkaline phosphatase (ALP) activity of osteoblast-like cells.

Replacement of Congenitally Missing Maxillary Lateral Incisor with Two-Buccal-Retainer Resin-Bonded Fixed Dental Prosthesis Modified by Proximal Boxes

A 21-year-old male patient with congenitally missing maxillary right lateral incisor presented to Fixed Prosthodontics Department at the Faculty of Dentistry, Damascus University (Damascus, Syria). A two-buccal-retainer lithium disilicate glass-ceramic resin-bonded fixed dental prosthesis (RBFDP) was chosen to replace the missing tooth. This clinical report describes a novel preparation design of two-buccal-retainer lithium disilicate glass-ceramic RBFDP modified by proximal boxes. A recall appointment after 3 years showed no fracture, no de-bonding, no secondary caries, and no staining in prosthesis margins. Color matching with natural teeth was excellent, and the patient was satisfied.

Effect of Different Etching Times with Hydrofluoric Acid on the Bond Strength of CAD/CAM Ceramic Material

The objective of this study was to evaluate the influence of hydrofluoric acid (HF) and conditioning time on the micro-shear bond strength (µSBS) between dual-cure resin cement and glass-ceramic materials, such as lithium disilicate ceramic (IPS e.max CAD, Ivoclar Vivadent) (EX) and leucite-reinforced ceramic (IPS Empress CAD, Ivoclar Vivadent) (EP), and also a hybrid ceramic (Vita Enamic, Vita Zahnfabrik) (VE). Eighteen sections with 1 mm thickness were cut from each CAD/CAM material and randomly divided into three groups, according to the surface etching time (30 s, 60 s, 90 s). The surface treatment was performed using 9.5% HF acid gel, then resin cement was applied on the prepared ceramic plates and light cured. µSBS values between resin cement and the ceramic material were measured with a universal testing machine at a crosshead speed of 0.5 mm/min until the failure occurred. The fractured surfaces of specimens were microscopically evaluated, and failure modes were classified as: adhesive between resin cement and ceramic, cohesive within ceramic or cement and mixed failure. Surface roughness of etched samples was examined using a scanning electron microscope. Obtained data were statistically analysed using one-way analysis of variance (ANOVA) and Bonferroni post hoc test with a level of significance α = 0.05. The results of the statistical methods applied indicate that µSBS mean difference for leucite-reinforced ceramic (EP) was statistically significant (p < 0.05). However, µSBS values for hybrid ceramic (VE) and lithium disilicate ceramic (EX) were not affected, from a statistical point of view, by the conditioning time (p > 0.05).

Adhesive application after ceramic surface treatment is detrimental to load-bearing capacity under fatigue of a lithium disilicate glass-ceramic

OBJECTIVE

To evaluate whether an adhesive application after surface treatment on a lithium disilicate ceramic (LD) has an influence on its load-bearing capacity under fatigue.

METHODS

LD discs (Ø= 10 mm; thickness= 1 mm) were allocated into 8 groups (n= 15), considering 3 factors: "ceramic surface treatment" - HF: hydrofluoric acid + universal primer application; or MEP: single-component ceramic primer; "adhesive application" - with or without; and "aging protocol" - baseline: 24 h to 7 days; or aging: 180 days of storage + 25,000 thermal cycles. The LD discs were adhesively bonded to glass fiber-reinforced epoxy resin discs (Ø= 10 mm; thickness= 2 mm) and stored according to the condition and each group. Cyclic fatigue testing (initial load= 100 N; step size= 100 N until600 N and after step size= 25 N to failure; 10,000 cycles/step; 20 Hz frequency) was performed. Fractographic and adhesive interface analyzes were also performed. The collected data were then analyzed by Kaplan Meier and Mantel-Cox tests and One-way ANOVA.

RESULTS

The adhesive application in the baseline condition had no influence on the load-bearing capacity under fatigue when the HF surface treatment was performed, however, adhesive application for the MEP treatment led to worse results than without it. The adhesive application in the aged condition showed worse fatigue outcomes for both treatments. All specimens presented radial cracks. MEP treatment followed by adhesive application presented the thickest luting layer.

CONCLUSION

The adhesive application after surface treatments of a lithium disilicate glass-ceramic is detrimental to its load-bearing capacity under fatigue when adhesively luted onto a supporting substrate.

Bonding of Clear Aligner Composite Attachments to Ceramic Materials: An In Vitro Study

Background: We aim to evaluate the effect of surface conditioning, bonding agents and composite types on surface roughness (SR) and shear bond strength (SBS) of clear aligner composite attachments bonded to ceramics. Methods: One hundred and eighty IPS e.max CAD specimens were prepared. For SR, 60 specimens were divided according to surface conditioning (n = 15) into four groups: control, 9.6% hydrofluoric acid (HFA), 37% phosphoric acid (PhA), air abrasion (AA). SR was measured using a Profilometer and Atomic Force Microscopy. For SBS, 120 specimens were divided according to conditioning methods (n = 40) (9.6% HFA and 37% PhA or AA), then according to bonding agents (n = 20) (Assure universal bond (AUB) or Single bond universal (SBU)) and then according to composite type (n = 10): Filtek™ Z350 and Filtek™ Z350 XT flowable composite. SBS was measured using Instron testing machine. Descriptive and group comparison were calculated (p < 0.05). Results: AA had the highest SR, while the control had the lowest SR (p < 0.05). HFA had the highest, but insignificant SBS, followed by AA (p > 0.05). AUB had higher SBS than SBU (p < 0.001). Filtek™ Z350 produced higher SBS than Filtek™ Z350 XT flowable composite (p < 0.01). Conclusion: The combination of AA, AUB, and Filtek Z350 produced the highest SBS, followed by HFA, AUB, and Filtek Z350.

Increasing Acid Concentration, Time and Using a Two-Part Silane Potentiates Bond Strength of Lithium Disilicate-Reinforced Glass Ceramic to Resin Composite: An Exploratory Laboratory Study

There is still a lack of consensus concerning the recommended etching concentration, application time and type of silane when bonding lithium disilicate-reinforced glass ceramics manufactured by CAD/CAM. The purpose of this study was thus to conduct an in vitro study which investigates the influence of hydrofluoric acid (HF) concentration, etching time and silane type on the microtensile bond strength (μTBS) of lithium disilicate to resin composites. Thirty-nine IPS e.max CAD blocks were randomly divided between thirteen groups (n = 3). The variables were HF concentration (9.5 or 4.9%), etching time (20 or 60 s) and silane type (Bis-Silane, Monobond Plus and ESPE Sil Silane). The blocks were cut into beams, aged for 10,000 cycles in a thermocycler and submitted to tensile stress to determine μTBS. A control group featuring the Monobond Etch & Prime (MEP) agent that combines etching/silanisation into a simultaneous process was also added. This group was discarded from the analysis due to only having pre-test failures. The data were analysed using a three-way ANOVA (α = 0.05). The HF concentration, etching time and silane type significantly influenced μTBS (p < 0.001). Significant interactions between time and silane type (p = 0.004), HF concentration and silane type (p < 0.001) and among the three factors (p < 0.001) were noted. Etching lithium disilicate with 9.5% HF (60 s), followed by the application of Bis-Silane, resulted in the highest μTBS (16.6 ± 9.0 MPa). The highest concentration and etching time under study, combined with a two-part silane, resulted in the highest bond strength, while the application of MEP showed a complete pre-test failure.

Shear bond strengths of two newly marketed self-adhesive resin cements to different substrates: A light and scanning electron microscopy evaluation

The purpose of this in vitro study was to compare the shear bond strengths (SBSs) of two newly marketed self-adhesive resin cements (RCs) to enamel, dentin, and lithium disilicate (LiSi) glass ceramic block. Forty-eight enamel and 48 dentin substrates were obtained from sound human molars. Additionally, 6 × 7 × 5 -mm- sized 24 specimens were produced from LiSi glass ceramic blocks. The tooth specimens were randomly assigned into four groups (n = 12) according to the surface treatments: (1) G-CEM ONE (GCO), (2) G-CEM ONE Adhesive Enhancing Primer (GCO-AEP) + GCO, (3) RelyX Universal (RXU), and (4) Scotchbond Universal Plus (SUP) + RXU. LiSi specimens were randomly divided into two groups (n = 12): (1) G-MultiPrimer (GMP) + GCO and (2) SUP + RXU. Following the RC applications, all specimens were kept in 100% humidity at 37°C for 24 hr and then submitted for SBS testing in a universal testing machine (1 mm/min). Data were analyzed by Welch's, one-way analysis of variance and two independent samples t tests. The nature of failures was examined under a light microscope, and scanning electron microscopy analyses were also performed for interfaces. GCO and RXU showed similar SBS to enamel (p > .05), and the use of adhesives resulted in improved SBS (p < .05). No difference was detected between GCO-AEP + GCO and SUP + RXU. The GCO-AEP + GCO exhibited the highest SBS to dentin (p < .05), followed by GCO ≥ SUP + RXU > RXU (p < .05). There was no significant difference between SBSs of two RCs to LiSi blocks (p > .05). No cohesive failure was determined for the tested groups by light microscope. The use of adhesives prior to the application of self-adhesive RCs improved their bonding to tooth tissues. GCO demonstrated superior SBS to dentin, whereas both self-adhesive RCs generated similar SBS to enamel and LiSi glass ceramic surfaces.

Surface Treatment Effect on Shear Bond Strength between Lithium Disilicate Glass-Ceramic and Resin Cement

OBJECTIVE

 The study aimed to evaluate the shear bond strength (SBS) of lithium disilicate glass-ceramic (LDGC) and resin cement (RC) using different surface treatments.

MATERIALS AND METHODS

 LDGC blocks (Vintage LD Press) were prepared, etched with 4.5% hydrofluoric acid, and randomly divided into seven groups (n = 10), depending on the surface treatments. The groups were divided as follows: 1) no surface treatment (control), 2) Silane Primer (KS), 3) Signum Ceramic Bond I (SGI), 4) Signum Ceramic Bond I/Signum Ceramic Bond II (SGI/SGII), 5) experimental silane (EXP), 6) experimental silane/Signum Ceramic Bond II (EXP/SGII), and 7) Experimental/Adper Scotchbond Multi-purpose Adhesive (EXP/ADP). The specimens were cemented to resin composite blocks with resin cement and stored in water at 37 °C for 24 hours. The specimens underwent 5,000 thermal cycles and were subjected to the SBS test. Mode of failure was evaluated under the stereo microscope.

STATISTICAL ANALYSIS

 Data were analyzed with Welch ANOVA and Games-Howell post hoc tests (α = 0.05).

RESULTS

 The highest mean SBS showed in group EXP/ADP (45.49 ± 3.37 MPa); however, this was not significantly different from group EXP/SGII (41.38 ± 2.17 MPa) (p ≥ 0.05). The lowest SBS was shown in the control group (18.36 ± 0.69 MPa). This was not significantly different from group KS (20.17 ± 1.10 MPa) (p ≥ 0.05).

CONCLUSIONS

 The different surface treatments significantly affected the SBS value between LDGC and RC. The application of pure silane coupling agent with or without the application of an adhesive improved the SBS value and bond quality.

The Bond Strength of a Universal Adhesive System with Silane to Lithium Disilicates in Comparison with an Isolated Silane Coupling Agent

PURPOSE

The aim of this in vitro study was to evaluate the effects of different durations of silane coupling agent application compared to a universal adhesive system regarding the shear bond strength of two ceramic materials.

MATERIALS AND METHODS

A total of 120 human molars were ground to the dentinal coronal third and then fixed into an acrylic resin holder. Lithium disilicate specimens were divided into two main groups according to the ceramic type: computer-aided design/computer-aided manufacturing IPS e.max CAD and heat-pressed Initial LiSi Press GC (dimensions of 4 × 3× 3 mm). Each main group was subdivided into 6 subgroups (n = 10) according to the duration of the silane and universal adhesive system application (20, 60, or 120 seconds) on the ceramic surface before cementation; then, the cementation procedures were performed. All specimens were subjected to 5000 thermal cycles at 5 and 55°C before testing. The shear bond strength was measured using a universal testing machine. ANOVA and Scheffe post hoc test multiple comparisons tests were conducted (α = 0.05).

RESULTS

The shear bond strength increased as the duration of the silane and universal adhesive system application increased. The highest bond value for each material was found for the silane application at 120 seconds, with a significant difference between 120 and 60, and 20 seconds for both e. max CAD and Initial LiSi materials (p = 0.029 and p ˂ 0.001, respectively). No significant difference was found between 60 and 20 seconds when silane and universal adhesive system were applied for both e. max CAD and Initial LiSi materials (p = 0.169 and p = 0.120, respectively). All groups treated with the silane primer showed significantly higher values than the universal adhesive system for each application time (p ˂ 0.001).

CONCLUSION

Increasing the duration of the silane coupling agent and universal adhesive system application to 120 seconds on the ceramic surface before cementation improved the shear bond strength of the ceramic-cement interface. Ceramic pretreatment with silane could be an essential step for bonding ceramic to dentin regardless of silane presence in the universal adhesive system.

Evaluation of the Bond Strength of Densely Sintered Ceramics Subjected to Extended Firing

Introduction

Critical failures in ceramic materials can be caused by the processing mode, which includes all steps taken in the manufacture of a ceramic part, from molding to firing.

Purpose

To evaluate the effect of extended firing on bond strength in densely sintered ceramics of the zirconium reinforced lithium silicate, lithium disilicate, and feldspathic ceramic.

Materials and Methods

Three types of ceramics were evaluated: zirconium reinforced lithium silicate, lithium disilicate, feldspathic ceramic. A total of 6 ceramic blocks, two for each material were used in the study. Each block was cut into four square sections. A total of 24 ceramic surfaces were randomly distributed into 6 groups (n = 4 surfaces per group) divided according to the variables: heat treatment: conventional firing or extended firing; test time: immediate (24 hours after cementation) or longevity (after 1000 cycles of thermocycling). The bond strength tests were performed in a semi-universal test machine for microshear bond strength. For data analysis, the Shapiro-Wilk test was performed to evaluate the normality between the groups measured, and regarding homoscedasticity (homogeneity of variances) by the Bartlett test. The comparisons between the groups were made using the nonparametric Kruskal-Wallis test.

Results

There was no statistically significant difference of the resistance values in relation to the thermal treatment methods (conventional firing and extended firing) in any ceramic group (p <0.05). Among the times (immediate and long), there was a statistically significant difference (p <0.05), with higher resistance values for immediate time.

Conclusion

Extended firing did not influence the micro-shear bond strength of zirconium reinforced lithium silicate, lithium disilicate, feldspathic ceramic.

Effect of lithium disilicate ceramic thickness, shade and translucency on transmitted irradiance and knoop microhardness of a light cured luting resin cement

This in vitro study evaluates the influence of pressed lithium disilicate thickness, shade and translucency on the transmitted irradiance and the Knoop microhardness (KHN) of a light-cured resin cement at two depths. One hundred and thirty-five ceramic discs of IPS e.max Press (Ivoclar Vivadent) were fabricated and divided into twenty-seven groups (n = 5) according to the association between translucency: HT (hight translucency), LT (low translucency), and MO (medium opacity); shade: BL2, A1 and A3.5; and thickness: 0.5 mm, 1.5 mm, and 2.0 mm. One side of each ceramic disc was finished, polished and glazed. The irradiance (mW/cm²) of a multiwave LED light curing unit (Valo, Ultradent) was evaluated with a potentiometer (Ophir 10ª-V2-SH, Ophir Optronics) without (control group) or with interposition of ceramic samples. The microhardness of Variolink Esthetic LC resin cement (Ivoclar Vivadent) was evaluated after 24 h at two depths (100 μm and 700 μm). Data were submitted to ANOVA followed by Tukey's test (α = 0.05). Irradiance and KHN were significantly influenced by ceramic thickness (p < 0.0001), shade (p < 0.001), translucency (p < 0.0001) and depth (p < 0.0001). Conclusions: the interposition of increasing ceramic thicknesses significantly reduced the irradiance and microhardness of resin cement. Increased depth in the resin cement showed significantly reduced microhardness for all studied groups. Increased ceramic opacity reduced the KHN of the resin cement at both depths for all ceramic thicknesses and shades.

Effect of Silane-Containing Universal Adhesives on the Bonding Strength of Lithium Disilicate

The purpose of this study was to investigate the effect of silane-containing universal adhesives on the bonding strength of lithium disilicate. Two-hundred-and-forty lithium disilicate blocks were divided into 16 groups according to the following surface treatments: hydrofluoric acid (HF)-treated or not, silane-treated or not, and the type of universal adhesive used (All-Bond Universal (ABU); Prime & bond (PB); Clearfil Universal Bond (CU); Single bond Universal (SBU)). After surface treatment, resin discs were bonded to each lithium disilicate using dual-cure resin cement. Bonded specimens were stored in distilled water for 24 h and then subjected to microtensile bond strength (μTBS) test. Failure modes were examined under stereomicroscope. Microscopic observation of bonded interfaces was analyzed using scanning electron microscopy. The μTBS data were statistically analyzed. Regardless of silane treatment, all groups treated with HF showed higher bonding strengths compared to those that were not treated with HF (p < 0.05). In groups treated with HF, the bonding strength increased after silane application (p < 0.05) except PB and CU (p > 0.05). Adhesive failures were dominant in all groups, but some mixed failures were observed in ABU treated with HF and silane. While most of the specimens that were not treated with silane after HF application only showed loose bonding between the ceramic and resin cement due to partial gaps, the specimens treated with silane application after HF showed a tight ceramic–resin interface. In conclusion, the silane in universal adhesives did not effectively improve the bonding strength between lithium disilicate and resin cement.

Two-Year Follow-Up of Self-Etching Ceramic Primer as Surface Treatment for Feldspathic Veneers: A Clinical Case Review

The two-step approach of applying hydrofluoric acid followed by silane is deemed the goldstandard surface treatment protocol before bonding to glass ceramics. Given hydrofluoric acid is a toxic conditioning agent and with the intention to simplify this step, the dental company Ivoclar Vivadent (Schaan, Lietchtenstein) released a self-etching ceramic primer, Monobond Etch & Prime in 2015, claiming that hydrofluoric acid and silane application would no longer be required prior to luting glass ceramics. Therefore, this clinical case report and retrospective analysis describes the replacement of unsatisfactory anterior veneers due to clinical failures for new feldspathic glass ceramic veneers, using the aforementioned self-etching ceramic primer. After two years, feldspathic glass ceramics presented satisfying clinical performance with absence of debonding, tooth sensitivity, recurrent carious lesions, or marginal infiltration.

Update on Enamel Bonding Strategies

Optimal strategies for the application of an adhesive differ between enamel and dentin because of the differences in their composition. The development of adhesive systems has mainly focused on the bonding of dentin, rather than on the enamel, by etching with phosphoric acid (PA). Dental adhesive technologies continue to rapidly advance, and various adhesive systems have been developed since the study of Buonocore in 1955. He introduced the enamel acid-etch technique. Then, the etch-and-rinse (ER) system was developed, and subsequently, the self-etch (SE) system. Universal adhesives are a new generation of one-bottle SE adhesives that can be applied with either ER mode or SE mode, or a combined system involving selective enamel etching mode. Since the combination of PA etching and the SE system differs from conventional ER systems, the enamel bonding strategy should be carefully considered. This concise review of the literature on reliable enamel bonding strategies should prove helpful to clinicians to choose an appropriate adhesive system to achieve optimal clinical outcomes.

The effect of different ceramic surface treatments on the repair bond strength of resin composite to lithium disilicate ceramic

This study aimed to evaluate the bonding abilities and long-term durability of different repair agents when applied to lithium disilicate ceramics (LDS). Blocks of IPS e.max CAD were prepared and divided into four groups according to the surface treatment: Monobond Etch & Prime (ME), K-etchant GEL+Clearfil Universal Bond (UB), Bondmer Lightless (BL), and K-etchant GEL+G-Multi Primer (GMP). All treated ceramic specimens were bonded to resin composite and light-cured. The micro-shear bond strength was measured after 24 h of water storage or 5,000 thermocycles. ME and BL showed significantly higher initial bond strengths than UB and GMP (p<0.05). After 5,000 thermocycles, there was no significant difference in ME (p>0.05), but BL and GMP showed considerable reduction in bond strength (p<0.05); moreover, the samples of UB were all de-bonded before testing. ME and BL proved to be effective surface treatment materials for LDS.

Long-term retention of lithium disilicate crowns with a current bioactive cement

OBJECTIVE

To determine if a recent bioactive cement provides acceptable lithium disilicate crown retention after long-term aging with monthly thermocycling.

MATERIALS AND METHODS

Extracted molars prepared with flat occlusal, 20° taper, ~4 mm axial. Prepared teeth assigned to two groups for equal mean surface areas per group. Lithium disilicate crowns fabricated with occlusal bar to facilitate removal. Crowns etched with 9.5%HF and cleaned. Cements were Ceramir Crown & Bridge QuikCap (CM) and Ketac Cem Maxicap (KC). Before cementation, specimens stored in 37°C water. Crowns cemented with 196 N force, placed in 37°C, 100% humidity oven for setting. Specimens thermocycled (5-55°C) 5000 cycles monthly for 6 months; otherwise stored in phosphate buffered saline solution. Crowns removed axially at 0.5 mm/min. Removal forces recorded and stresses calculated using areas. Independent t-test (α = 0.05).

RESULTS

Levene test not significant (P = 0.649). CM removal stresses and forces (P < 0.001) were higher (1.93 MPa, 261.4 N) compared to KC (1.06 MPa, 139.4 N). CM cement found principally on crown intaglio, KC found with most cement on prepared tooth. Chi-square significant (P < 0.001).

CONCLUSIONS

Following long-term aging with monthly thermocycling, lithium disilicate crowns were best retained by CM cement, however both cements are capable of retaining lithium disilicate crowns with preparations of ideal taper and length.

CLINICAL SIGNIFICANCE

Results serve as a basis for bioactive cement selection for retaining lithium disilicate crowns. Without optimal axial length, taper of preparation or retentive features, Ceramir Crown and Bridge QuikCap offers a bioactive cement with improved long-term retention when compared to Ketac Cem Maxicap for lithium disilicate crowns.

Effect of post etching cleansing on surface microstructure, surface topography, and microshear bond strength of lithium disilicate

Aim:

This study assessed the effect of postetch cleansing on the surface microstructure, surface topography, and microshear bond strength (μSBS) of lithium disilicate and the resin cement.

Setting and Design:

In Vitro analytical study.

Materials and Methods:

Fifteen discs (10 mm diameter and 2 mm thickness) were fabricated from highly translucent lithium disilicate IPS Emax 2 ceramic (Ivoclar Vivadent, Schaan, Liechtenstein). Four resin cement (RelyX Ultimate, 3M ESPE) cylinders (0.9 mm diameter and 4 mm high) were placed on each ceramic disc (total n = 60). The samples were divided into three groups based on the surface treatment of the ceramic discs (20 resin cement cylinders on 5 discs in each group). Group I (HF) (control) etched with 9.6% HF with no postetch cleansing, Group II (HFP) etched with 9.6% HF for 20 s followed by rinsing with water and postetching cleansing with 37% phosphoric acid, and Group III (HFPU) etched with 9.6% HF followed by active application of 37% phosphoric acid followed by postetch cleansing in ultrasonic bath for 5 min. μSBS of resin cement to ceramic surfaces was tested following a standard protocol. Surface roughness was evaluated using an atomic force microscope. Surface topography and elemental analysis were analyzed using SEM/EDX. Mode of failure was also assessed.

Statistical Analysis Used:

The data were analysed using one way analysis of variance and post hoc tukeys test.

Results:

The μSBS were found to be highest for Group III (HFPU), followed by Group II (HFP) followed by Group I (HF) and were statistically significant. There was a difference in the surface topography and surface microstructure between the three groups. Mode of failure was predominantly adhesive.

Conclusion:

The μSBS, surface topography, and surface microstructure were found to be superior in the groups, in which postetch cleansing was done as compared to the control in which no postetch cleansing was done.

Effect of different surface treatments and multimode adhesive application on the Weibull characteristics, wettability, surface topography and adhesion to CAD/CAM lithium disilicate ceramic

This paper aims to evaluate the effect of different surface treatments on surface topography, wettability, and shear bond strength of resin cement to glass ceramic.

Effect of etching with low concentration hydrofluoric acid on the bond strength of CAD/CAM resin block

The effect of etching for 90 s with low concentrations (0.5, 1.0, 2.0, 3.0, 3.5, and 4.0%) of hydrofluoric acid (HF) on the adhesiveness of computer-aided design/computer-aided manufacturing (CAD/CAM) resin blocks [CERASMART (CS), SHOFU BLOCK HC (HC), KATANA AVENCIA Block(KA), and VITA ENAMIC (EN)] was investigated. Energy dispersive spectroscopy revealed that the silicon content of HC, KA, and EN groups remained almost constant with HF etching of ≤4%. HF etching increased the surface roughness of all blocks. The HF concentration resulting in the highest shear bond strength in each group was as follows: CS (2.0%), HC (3.0%), KA (3.5%) and EN (0.5%). Scanning electron microscopy revealed that the bonding interface of etched surfaces differed significantly from that of airborne-particle abrasion surfaces. Thus, low concentration HF etching is effective for surface treatment of CAD/CAM resin blocks. The etching effect and optimum HF concentration differ with the block composition and structure.

Adhesive dentistry: Current concepts and clinical considerations

OBJECTIVES

To address contemporary concepts in adhesive dental materials with emphasis on the evidence behind their clinical use.

OVERVIEW

Adhesive dentistry has undergone major transformations within the last 20 years. New dental adhesives and composite resins have been launched with special focus on their user-friendliness by reducing the number of components and/or clinical steps. The latest examples are universal adhesives and universal composite resins. While clinicians prefer multipurpose materials with shorter application times, the simplification of clinical procedures does not always result in the best clinical outcomes. This review summarizes the current evidence on adhesive restorative materials with focus on universal adhesives and universal composite resins.

CONCLUSIONS

(a) Although the clinical behavior of universal adhesives has exceeded expectations, dentists still need to etch enamel to achieve durable restorations; (b) there is no clinical evidence to back some of the popular adjunct techniques used with dental adhesives, including glutaraldehyde-based desensitizers and matrix metalloproteinase inhibitors; and (c) the color adaptation potential of new universal composite resins has simplified their clinical application by combining multiple shades without using different translucencies of the same shade.

CLINICAL SIGNIFICANCE

New adhesive restorative materials are easier to use than their predecessors, while providing excellent clinical outcomes without compromising the esthetic quality of the restorations.

Current perspectives on dental adhesion: (1) Dentin adhesion - not there yet

The essential goal of any adhesive restoration is to achieve a tight and long-lasting adaptation of the restorative material to enamel and dentin. The key challenge for new dental adhesives is to be simultaneously effective on two dental substrates of conflicting nature. Some barriers must be overcome to accomplish this objective. While bonding to enamel by micromechanical interlocking of resin tags within the array of microporosities in acid-etched enamel can be reliably achieved and can effectively seal the restoration margins against leakage, bonding effectively and durably to organic and humid dentin is the most puzzling task in adhesive dentistry.

Much of the research and development of dental adhesives has focused on making the clinical procedure more user-friendly by reducing the number of bottles and/or steps. Although clinicians certainly prefer less complicated and more versatile adhesive materials, there is a trade-off between simplification of dental adhesives and clinical outcomes. Likewise, new materials are launched with claims of being novel and having special properties without much supporting evidence.

This review article discusses dental adhesion acknowledging pioneer work in the field, highlights the substrate as a major challenge to obtain durable adhesive restorations, as well as analyzes the three adhesion strategies and their shortcomings. It also reviews the potential of chemical/ionic dental adhesion, discusses the issue of extensively published laboratory research that does not translate to clinical relevance, and leaves a few thoughts in regard to recent research that may have implications for future adhesive materials.

Effect of various surface treatments on the bond strength of resin luting agent and the surface roughness and surface energy of CAD/CAM materials

The aim of this study was to examine the effect of various surface treatments on the bond strength of a resin luting agent and the surface roughness and surface energy of computer-aided design and computer-aided manufacturing (CAD/CAM) materials. Four types of CAD/CAM blocks (Shofu Block HC: BHC; GC Cerasmart: CER; VITA Enamic: ENA; and Lava Ultimate: LAV) were used. All blocks were randomly divided into eight groups based on the surface treatment as follows: no surface treatment (C), airborne-particle abrasion (AA), hydrofluoric acid etching (HA), silane coupling agent application (SL), AA/SL, HA/SL, AA/HA, and AA/HA/SL. The microtensile bond strength (µTBS), surface roughness and surface energy were measured. Three-way ANOVA revealed that all surface treatments significantly influenced the µTBS between the resin luting agent and all types of CAD/CAM materials; however, the effect of each surface treatment on surface roughness and energy was dependent on the CAD/CAM materials.

Dentin microshear bond strength of various resin luting agents to zirconia-reinforced lithium silicate ceramics

STATEMENT OF PROBLEM

The performance of adhesive and resin luting cements used to bond zirconia-reinforced lithium silicate (ZLS) ceramics to dentin has not been well established.

PURPOSE

The purpose of this in vitro study was to examine the microshear bond strength (μSBS) of an etch-and-rinse adhesive system, a universal adhesive, and a self-adhesive resin cement that were used to bond ZLS to dentin.

MATERIAL AND METHODS

VITA Suprinity (VS) and Celtra Duo (CD) blocks were sectioned into 36 and 72 microbars (1×1×3 mm). All VS were crystallized, while half of CD were additionally fired and defined as fired-Celtra Duo (FCD). The others were defined as unfired-Celtra Duo (UCD). Each microbar was cemented to each flat occlusal dentin surface of a human first premolar, following the adhesive luting systems: Scotchbond Multi-purpose (SM), Single Bond Universal (SU) combined with RelyX Ultimate, and RelyX Unicem (U2) (n=12 per group). μSBS at 24 hours was then determined, and the data were analyzed by using 2-way ANOVA and a Tukey post hoc test (α=.05). Failure modes were analyzed under a stereomicroscope at ×40 magnification.

RESULTS

Two-way ANOVA revealed that the type of ZLS had no influence on μSBS (P=.699). However, the kinds of adhesive luting cements and their interaction had a statistically significant effect on μSBS (P<.001 and P=.002). U2 had a statistically significant lower mean μSBS, regardless of the type of ZLS, than SM and SU (P≤.05), while UCDU2 did not show a statistically significant difference in μSBS from UCDSU (P=.478).

CONCLUSIONS

Resin cement used with an etch-and-rinse and a universal adhesive agent demonstrates higher bond strength for the cementation of zirconia-reinforced lithium silicate ceramics to dentin than a self-adhesive resin cement.

Two-year Follow-up of Ceramic Veneers and a Full Crown Treated With Self-etching Ceramic Primer: A Case Report

CLINICAL RELEVANCE

The Monobond Etch & Prime seems to be an efficient option for adhesive cementation of ultrathin veneers and full crown ceramic with good properties after two years of clinical follow-up.

SUMMARY

The use of the self-etching ceramic primer combines the stages of acid conditioning and silanization in cementation procedures of ceramic restorations. The protocol is a simpler and safer alternative to the conventional protocol for surface treatment of silica-based ceramics. This case report describes the steps of an esthetic rehabilitation with ultrathin veneers and full crown based on lithium disilicate treated with a ceramic primer (Monobond Etch & Prime, Ivoclar Vivadent, Schaan, Liechtenstein). After two years of clinical follow-up, the restorations presented satisfactory esthetic and functional performance, color stability, surface and marginal integrity, and absence of cracks and debonding. More research is needed to investigate the clinical performance and longevity of the ceramic restorations treated with self-etching ceramic primers.

Evaluation of bond strength of dual resin cements to CAD/CAM-created lithium disilicate ceramic

BACKGROUND

The objective was to examine the microshear bond strength values of different dual resin cements to computer-aided design (CAD)/computer-aided manufacturing (CAM)-created ceramics containing lithium disilicate, which underwent different surface treatments.

METHODS

Two dual resin cements (RelyX ARC and RelyX Ultimate) and three surface treatments of lithium disilicate ceramic blocks (Ceramic Primer (CP; containing silane) plus Adper Scotchbond Multipurpose (ASM) adhesive; CP plus Single Bond Universal (SBU) adhesive; and SBU adhesive alone) were tested. The SBU adhesive includes silane in its formulation. Each sample underwent a microshear test and bond strength values were subjected to analysis of variance (ANOVA) followed by Tukey's test (α=0.05). Fracture patterns were also observed with light microscopy.

RESULTS

RelyX ARC treated with CP+ASM or CP+SBU presented resistance values that were significantly higher than the same treatments for RelyX Ultimate. Conversely, for the blocks treated with SBU alone, the mean resistance value for RelyX Ultimate was higher than that of RelyX ARC. Regarding the different types of treatment for each resin, the mean resistance value of RelyX ARC treated with CP+ASM was significantly highest, followed by treatment with CP+SBU and SBU treatment alone. Meanwhile, RelyX Ultimate treated with CP+ASM or CP+SBU presented resistance values that were significantly higher than SBU treatment alone. In all of the groups, an adhesive fracture pattern was predominantly observed.

CONCLUSIONS

The present results indicate that silanization is important for ASM and SBU adhesives to be effective.

Effect of experimental resin cements containing thio-urethane oligomers on the durability of ceramic-composite bonded interfaces

Thio-urethane oligomers improve conversion and mechanical properties of resin cements. The objective of this study was to evaluate the effect of resin cements formulated with thio-urethane (TU) oligomers on microtensile bond strength (µTBS) of ceramics to composites subjected to thermal/mechanical cycling. Methods: BisGMA/UDMA/TEGDMA (50/30/20 wt%) containg 0 (control, EC) or 20 wt% aliphatic or aromatic thiourethane (HDDI and BDI, respectively) were mixed with CQ/amine (0.2/0.8 wt%) and 25 wt% 0.7um Ba glass. Rely X Ultimate (RU-3M ESPE) was used as the commercial control. The cements were sandwiched between ceramic (IPS e.max Press) and resin composite blocks (Filtek Supreme, 3 M-ESPE). Eight bonded blocks were produced per experimental group. Prior to bonding, ceramic surfaces were etched (20 s - 10% HF) and silanized. Composite surfaces were treated with Single Bond Universal (3 M ESPE). Specimens were stored for 24 h in distilled water at 37 °C, and then either tested immediately, or subjected to thermal (10,000, 5 °C and 55 °C) or mechanical cycling (300,000 cycles). Sticks (1 mm², average of 25 sticks per block) were cut and tested for µTBS (1.0 mm/min). Data were analyzed with two-way ANOVA/Tukey's test (α = 5%). Fracture surfaces were analyzed to determine failure modes. Results: The µTBS for HDDI and RU was significantly higher than BDI and EC cements. BDI led to significantly higher µTBS than EC after 24 h, Tc and Mf. µTBS decreased significantly after thermal/mechanical cycling for all groups. Failure modes were predominantly adhesive or mixed. Significance: The use of selected thio-urethane oligomers was able to increase the µTBS of composite-cement-ceramic specimens. Tc and Mf reduced µTBS for all resins cements.

Bonding Strength of Universal Adhesives to Indirect Substrates: A Meta-Analysis of in Vitro Studies

PURPOSE

To evaluate the in vitro bond strength of universal adhesive systems to indirect substrates.

MATERIAL AND METHODS

Two reviewers performed a literature search up to March 2018 in seven databases: PubMed, Web of Science, SciELO, Scopus, LILACS, IBECS, and BBO. The review included studies that compared the bond strength of universal adhesives and well-established material-specific primers to indirect substrates: lithium disilicate ceramic, yttrium-stabilized zirconium dioxide ceramic, leucite-reinforced ceramic, feldspathic porcelain, polymer infiltrated ceramic material, resin composite or metal alloys. Analyses were carried out using RevMan 5.3.5. A global comparison was performed with the standardized mean difference using a random-effects models at a significance level of p < 0.05.

RESULTS

A total of 45 studies were included in the qualitative analysis, and the meta-analysis was performed with 42 studies. Bond strength to glass-based ceramics and alloys was improved with the use of a specific-primer as separate step before the bonding procedures (lithium disilicate, p < 0.001; alloys, p < 0.001). The bond strength to zirconium substrates was improved with the use of universal adhesives (p < 0.001). For bond strength to composite resin as indirect substrate, universal adhesives performed in a manner similar to that of the material-specific primer (p = 0.11).

CONCLUSIONS

The clinical procedure of luting zirconia and resin composite restorations could be simplified by using single-bottle universal adhesives. However, the ability of universal adhesives to achieve an adequate and durable bond to glass-based ceramics and alloys appears to be limited.

Different bonding agents effect on adhesive bond strength: lithium disilicate glass ceramic

Abstract Introduction The silanization of the ceramic surface prior to applying the adhesive and/or resinous materials plays an important role in bond strength. Nowadays, a new family of adhesive systems has been introduced into the market, aiming to simplify the technique of adhesive procedures during cementation. Objective To investigate the effectiveness of different bonding agents containing silane and primer on Lithium Disilicate Glass Ceramic (LD) surface by shear bond strength tests. Material and method 130 LD ceramic blocks were included in acrylic resin, polished and washed in ultrasound for 10 minutes. The specimens were divided into 2 groups according to surface treatment: Polished Surface (PS); Hydrofluoric Acid 9.5% - 20s (HF). Each group was divided into 5 subgroups (n = 13) according to bonding agent type: metallic primer containing MDP (ZPrimePlus, Bisco Inc); two traditional silanes (MonobondPlus, IvoclarVivadent / Porcelain Prime, Bisco Inc.); mixture of silane and resin (Kerr Silane, Kerr); mixture of silane and universal adhesive (Single-bond Universal, 3M Espe). The specimens were mounted in a standard device for shear testing (UltradentBonding Assembly), cemented with dual resin cement (RelyX UltimateTM, 3M Espe.) and photo-polymerized for 20s. The samples were tested after 24 hours and 3 months of storage in distilled water at ±36 °C. The data were analyzed by 3-Way Anova and Tukey's test (α = 5%). Result Shear bond strength (SBS) was significantly influenced by surface treatment, bonding agent used and storage (p <0.001). Conclusion Adequate adhesive bond strength to Lithium Disilicate Glass Ceramic can be obtained with traditional silanes, combined with HF acid pretreatment surface.

Effect of Hydrofluoric Acid Concentration and Thermal Cycling on the Bond Strength of Brackets to Ceramic

This study to evaluate the effects of different hydrofluoric acid (HF) concentrations and thermal cycling on the shear bond strength (SBS) of brackets to ceramic. Cylinders of ceramic were divided into 10 groups (n=15), according to HF concentrations: 1-1%;2-2.5%;3-5%;4-7.5%;5-10% (storage 24 h); 6-1%;7-2.5%;8-5%;9-7.5%; and, 10-10% (thermal cycling). All cylinders were etched for 60s and received one layer of silane. Metallic brackets were bonded to the cylinders using Transbond-XT, light activated for 40 s, using a LED (Radii Plus) and stored in deionized water at 37o C for 24h. The groups 6 to 10 were submitted to thermal cycling (7,000 cycles - 5o/55oC). SBS was performed in an Instron at crosshead speed of 1.0 mm/min. Data were submitted to two-way ANOVA and Tukey's post-hoc test (α=0.05). The Adhesive Remaining Index (ARI) was evaluated at 40x magnification. The different HF acid concentrations influenced on the SBS of the brackets to ceramic (p<0.05). The thermal cycling decreased the SBS of the brackets to ceramic for all acid concentrations (p<0.05). The ARI showed a predominance of scores 0 for all groups, with an increase in scores 1, 2 and 3 for the group storage for 24 h. In conclusion, the different HF acid concentrations 5.0%, 7.5% and 10% influenced on the SBS of brackets to ceramic. The thermal cycling decreased significantly the SBS of brackets to ceramic.

Bond Stability of Universal Adhesives Applied To Dentin Using Etch-And-Rinse or Self-Etch Strategies

This study evaluated the immediate and 6-month dentin bond strength of universal adhesives used in etch-and-rinse or self-etch bonding strategies. The adhesives tested were Ambar Universal, G-Bond, Single Bond Universal, Tetric N-Bond Universal, and Ybond Universal. Gold standard adhesives (Scotchbond Multipurpose Plus and Clearfil SE Bond) were controls. Microtensile dentin bond strength (n=5 teeth), pH, and C=C conversion (n=3) were evaluated. Data were analyzed at α=0.05. All adhesives showed differences in pH. Ybond had intermediately strong aggressiveness, whereas the others were ultra-mild. The C=C conversion was different in most adhesives. In the etch-and-rinse strategy, all adhesives showed similar results generally except for G-Bond, which had lower bond strength than most adhesives. G-Bond and Tetric-N-Bond showed lower bond strengths after 6 months compared with 24 h, whereas the other adhesives had stable dentin bonds. In the self-etch strategy, G-Bond had lower bond strength than most adhesives. After 6 months, Ambar was the only adhesive showing lower dentin bond strength compared with 24 h. Most adhesives had discreet drops in bond strength during aging when used in the self-etch strategy. The failure modes were also material dependent, with a general pattern of increased adhesive and/or pre-testing failures after storage. In conclusion, the bonding performance of universal adhesives to dentin is material dependent. Most adhesives had stable dentin bonds with results comparable to the gold standard materials, particularly when applied in the self-etch mode. In general, it seems the use of universal adhesives in dentin should not be preceded by phosphoric acid etching.

HF etching of CAD/CAM materials: influence of HF concentration and etching time on shear bond strength

Background

The required pretreatment of CAD/CAM ceramic materials before resin composite cement application varies among studies. The aim of the present study was to evaluate the effect of hydrofluoric acid concentration and etching time on the shear bond strength (SBS) of two adhesive and two self-adhesive resin composite cements to different CAD/CAM ceramic materials.

Methods

SBS of two adhesive (Panavia V5, Kuraray, [PV5]; Vita Adiva F-Cem, Vita Zahnfabrik, [VAF]) and two self-adhesive (RelyX Unicem 2 Automix, 3 M Espe, [RUN]; Vita Adiva S-Cem, Vita, [VAS]) cements to four different CAD/CAM materials (Vitablocs Mark II, Vita, [VM]; Vita Enamic, Vita, [VE]; e.max CAD, Ivoclar Vivadent, [EC]; Vita Suprinity PC, Vita, [VS]) was measured. The effect of the surface pretreatment by using two different hydrofluoric acid products (HF5% Vita Ceramics Etch, Vita and HF9% buffered, Ultradent Porcelain Etch, Ultradent Products) were assessed at etching times of 0 s, 5 s, 15 s, 30s and 60s for each cement and restorative material combination (n = 10 per group, total n = 1440).

Results

Significant effects were found for the etching time and cement for all materials with highest shear bond strength for etching times of 60s = 30s = 15 s ≥ 5 s > 0 s and for RUN>PV5 = VAF > VAS (p < 0.05). Etching with HF5% for 5 s to 15 s resulted in higher SBS values, while no differences were observed between HF5% and HF9% buffered when the substrates were etched for 30s to 60s (p < 0.05).

Conclusions

Within the limitations of this study the recommended surface pretreatment of silicate ceramics is HF etching with concentrations of 5% or 9% for 15 s to 60s to achieve highest shear bond strength while the glassy matrix is sufficiently dissolved. The tested resin composite cements can be applied with all tested materials and suggested for clinical application.

Effect of universal adhesives on microtensile bond strength to hybrid ceramic

Background

The aim of this study was to evaluate the effect of universal adhesives (UA) and silane on the microtensile bond strength (μTBS) of resin cement to a hybrid ceramic Vita Enamic (VE).

Methods

VE specimens were acid etched using hydrofluoric acid (HF) and were assigned to three groups (n = 10) based on the applied bonding technique. In group 1 (S), a silane-based primer was used as a surface treatment prior to the application of a resin cement (Variolink Esthetic DC). In group 2, a silane-containing UA, Clearfil Universal Bond (CUB) was used for the surface treatment, and in group 3, A silane-free UA, Tetric N-Bond Universal (TNU) was used for surface treatment. Resin cement build-ups were prepared. The bonded specimens were sectioned into resin-ceramic beams. Half of the beams of each group were stored for 24 h at 37 °C and the other half were subjected to a thermo-cycling aging. The microtensile bond strength (μTBS) was measured at a crosshead speed of 0.5 mm/min. Failure modes were assessed accordingly. Data were analyzed using a) two-way analysis of variance ANOVA followed by one-way ANOVA and Tukey tests between groups and b) independent t-test to detect differences (α = 0.05) for each group. The surface topographies of the ceramic surface were evaluated using scanning electron microscopy.

Results

The results showed that silane-based primer (S) application resulted in significantly higher (p < 0.05) μTBS values after 24 h and after thermocycling compared to both silane-containing UA (CUB) and silane-free UA (TNU). The μTBS values of all groups were significantly reduced after thermocycling. No statistically significant difference was observed between the μTBS of CUB and TNU after 24 h. However, TNU showed significantly higher μTBS after thermocycling. Different failure modes were observed, and adhesive failure was the most common in all groups. Marked surface topographic changes were observed following HF etching.

Conclusion

It is concluded that, the UAs tested cannot be recommended as substitutes to the silanization of Hybrid ceramic.