Effect of different adhesive strategies on microtensile bond strength of computer aided design/computer aided manufacturing blocks bonded to dentin

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.

Marginal gap and fracture resistance of CAD/CAM ceramill COMP and cerasmart endocrowns for restoring endodontically treated molars bonded with two adhesive protocols: an in vitro study

Endocrowns represent a conservative and esthetic restorative alternative to full coverage crowns. They can be constructed using various CAD/CAM materials that can provide a modulus of elasticity similar to that of teeth. The ability to use of such materials in composite blocks that can be easily repaired is also an advantage, provided appropriate bonding performance is ensured. This study, therefore, evaluated the marginal gap and fracture resistance of two CAD/CAM endocrown materials using two bonding protocols. Thirty-two mandibular molars were evaluated in two groups based on the material type: a Cerasmart group (GC America Inc; n = 16) acting as the control and a Ceramill COMP group (Amann Girrbach, Germany; n = 16). These groups were then classified according to the bonding protocol used: a total-etch bonding protocol (n = 8) and a self-etch bonding protocol (n = 8) implemented using RelyX ultimate adhesive resin cement (3M ESPE). The samples were then subjected to aging by simulating a 1-year thermo-mechanical process. The marginal gap results were statistically insignificant across the material and bonding protocol groups before thermo-mechanical aging. Thermo-mechanical aging significantly reduced the marginal gap distance for Ceramill COMP endocrowns cemented using the total-etch protocol (p = 0.002). No statistically significant difference was recorded for the fracture resistance in either the material or bonding protocol groups (p ≥ 0.05). Both materials and bonding protocols can, therefore, be used in the posterior region providing conservative treatment, adequate marginal gap and fracture resistance.

Adhesive Systems Used in Indirect Restorations Cementation: Review of the Literature

New technologies are changing the therapeutical options to do indirect restorations and new adhesive systems are continuously introduced to be used by clinicians. Different interactions between restorations, adhesive systems components, enamel and dentin require having criteria based on the selection of the adhesive system, ensuring the longevity of the restorations and the preservation of the biological remnant. The adhesion force to the dental tissue is one of the indicatives of the behavior of the adhesive systems and influences the behavior of the treatments with direct and indirect restorations. The objective of this search was to find the adhesive systems with the best results in terms of the adhesion strength of indirect restorations on the dental tissues. The search was conducted in two MEDLINE digital databases (PubMed), and the Cochrane Library with a search strategy based on the combination of MeSH (Medical Subject Headings) keywords. This systematic review used the PRISMA guide (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). According to this review, the 3-step adhesive systems were the best performing and still are the gold standard for the cementing of indirect restorations. In addition, it can be concluded that self-etched adhesive systems reduce the time spent in clinical practice, however at the interface level they behave as permeable membranes more susceptible to degradation.

Effectiveness of current adhesive systems when bonding to CAD/CAM indirect resin materials: A review of 32 publications

The purpose of this review was to assess the available literature regarding bonding between current adhesive systems and computer-aided design/computer-aided manufacturing (CAD/CAM) indirect resin materials, to provide clinicians with a comparative overview of the relevant bonding procedures. An electronic search was performed through PubMed based on the keywords CAD/CAM and dental bonding. Additional relevant literature was obtained from the citations in the articles. A total of 313 papers were identified, of which 281 were excluded as being unsuitable, and an additional 3 papers were identified, giving a total of 32 articles that are included in this review. Based on this survey, it is recommended that microretentive surfaces should be generated by either blasting or hydrofluoric acid etching. This initial process should be followed by silanization to ensure chemical adhesion prior to bonding to CAD/CAM indirect resin composite materials (including Lava Ultimet, KATANA AVENCIA block, Gradia Block, Cerasmart, Paradigm, and Block HC) and CAD/CAM polymer-infiltrated ceramics (such as Vita Enamic). The use of materials containing methyl methacrylate (MMA) also appears to improve the bonding of CAD/CAM poly(methyl methacrylate) (PMMA) resin materials (including XHIPC-CAD/CAM, artBloc Temp, and Telio).

Effect of different resin cements and surface treatments on the shear bond strength of ceramic-glass polymer materials

STATEMENT OF PROBLEM

The effect of different surface treatment techniques on the bond strength of different types of ceramic-glass polymer computer-assisted design and computer-assisted manufacturing (CAD-CAM) materials and resin cements after aging is unknown.

PURPOSE

The purpose of this in vitro study was to evaluate the surface roughness of different ceramic-glass polymer CAD-CAM materials after 2 different surface treatments and the effect of material, surface treatment, resin cement, and aging on bond strength. Additionally, it was to determine any correlation between the surface roughness and bond strength.

MATERIAL AND METHODS

CAD-CAM ceramic-glass polymer materials, a polymer-infiltrated ceramic network (PICN) (VITA ENAMIC), a resin nanoceramic (Lava Ultimate), and a nanoparticle-filled resin (Cerasmart) (1.5 mm in thickness; n=144) were divided into 2 subgroups in terms of surface treatments: airborne-particle abraded or silica-coated. The surface roughness values of specimens were measured. Composite resin cylinders were prepared and bonded to the restorative specimens using 2 different types of resin cements (dual-polymerizing [DP] and light-polymerizing [LP]). Half of the specimens were stored in distilled water for 24 hours, while the other half were submitted to 5000 thermocycles. The shear bond strength was measured, and the failure modes of the specimens were evaluated. The data were analyzed with ANOVA and Tukey HSD tests (α=.05). The correlation between roughness and bond strength values was analyzed using Pearson correlation analysis.

RESULTS

Material (P=.012) and surface treatment type (P=.031) significantly affected the surface roughness. For bond strength, significant interactions were found among the material type, surface treatment, resin cement, and aging factors (P=.009). No significant correlation was found between roughness and bond strength (P=.943).

CONCLUSIONS

The surface treatment and resin cement type affected the bond strength and surface roughness of tested restorative materials. DP resin cement provided higher bond strength for airborne-particle abraded nanohybrid composite resin materials. LP resin cement achieved a higher bond strength when used with silica-coated, nanoparticle-filled resin and PICN materials.