A randomized, controlled clinical evaluation of two resin cement systems in the adhesion of CAD/CAM-fabricated resin nanoceramic restorations: 18-month preliminary results.

OBJECTIVE: The purpose of this clinical study was to evaluate the performance of two different adhesive resin cement systems in the cementation of inlay/onlay restorations produced from resin nanoceramic blocks using the CAD/CAM system. MATERIALS AND METHODS: A total of 70 inlay/onlay restorations made from Cerasmart (GC, Tokyo, Japan) resin nanoceramic blocks using CEREC Omnicam (Sirona Dental, Bensheim, Germany) were placed in 53 patients. The restorations were cemented with RelyX U200 Automix (3M ESPE, Seefeld, Germany) self-adhesive resin cement (RXU) after selective enamel etching or with G-CEM LinkForce (GC, Tokyo, Japan) adhesive resin cement (GCL) in combination with a universal adhesive (G-Premio Bond) in selective etch mode. At baseline and after 6, 12, and 18 months, restorations were examined by two calibrated clinicians according to modified USPHS criteria. The data were analyzed using Chi-square (χ2 ) test and Friedman test (p < 0.05). RESULTS: After 18 months, two teeth at RXU group were endodontically treated due to hypersensitivities. At GCL group, three restorations were lost due to debondings (2) and ceramic fracture (1). The survival rates of RXU (94.3%) and GCL group (91.4%) exhibited no statistically significant difference (p = 0.661). No significant differences were detected for surface texture, secondary caries, anatomic form, color match, marginal discoloration, marginal integrity, interproximal contacts, and patient satisfaction (p > 0.05). CONCLUSIONS: The two resin cement systems showed acceptable clinical performance for the cementation of resin nanoceramic CEREC Omnicam inlay/onlay restorations. CLINICAL SIGNIFICANCE: Resin nanoceramic restorations fabricated using CEREC Omnicam and cemented with either a self-adhesive or a universal adhesive/resin cement system demonstrated clinically acceptable results for posterior teeth in a single visit.

A clinical evaluation of resin nanoceramic CEREC Omnicam restorations associated with several factors.

PURPOSE: The aim of this study was to assess the clinical performance of computer-aided design and computer-aided manufacturing resin nanoceramic posterior restorations fabricated by CEREC Omnicam system. MATERIALS AND METHODS: Fifty-seven Lava Ultimate posterior restorations were placed in 44 patients by one operator. Restorations were cemented using a resin cement system (Duo-Link). The clinical performance of the restorations was evaluated with USPHS guidelines in a mean time of 45-month. Data were statistically analyzed using Kaplan-Meier and Log Rank (Mantel-Cox) tests (SPSS 22.0, α = 0.05). RESULTS: Thirty-eight restorations in 26 patients were evaluated at recall examinations by two evaluators other than the clinician who had placed the restorations who were blinded to groups. The survival rates of Lava Ultimate were 86.8%. A total of 5 (13.2%) failures were found. After a mean time of 45-month survival rate of vital and non-vital teeth were 90 and 83.3% respectively. The failures were not significantly influenced by gender, tooth arch, restoration size, the treated region and vitality. CONCLUSION: Chair-side posterior resin nanoceramic restorations were clinically successful restorations with a survival rate of 86.8% after a mean time of 45-month. CLINICAL SIGNIFICANCE: Chair-side CAD/CAM resin nanoceramic restorations can be a successful choice for vital and non-vital teeth with acceptable survival rates.

Effects of ceramic shade and thickness on the micro-mechanical properties of a light-cured resin cement in different shades.

OBJECTIVE: The aim of this study was to evaluate the micro-mechanical properties of a light-cured resin cement in four different shades when polymerized through a leucite-reinforced glass-ceramic in different shades and thicknesses. MATERIALS AND METHODS: A light-cured resin cement in four different shades (HV+1, HV+3, LV-1 and LV-3) was selected for this study. The specimens were cured by using a LED-unit (Bluephase®, IvoclarVivadent) for 20 s under a leucite-reinforced glass-ceramic (IPS Empress® CAD, IvoclarVivadent) in two different shades (A1 and A3) of different thicknesses (1 and 2 mm). Specimens cured directly, without an intermediate ceramic, served as control. The specimens were stored after curing for 24 h at 37°C by maintaining moisture conditions with distilled water. Micro-mechanical properties (indentation modulus, E; Hardness, HV; creep, Cr) of the resin cements were measured with an automatic microhardness indenter (Fisherscope H100C, Germany). Twenty groups were included (n = 3), while 10 measurements were performed on each specimen. Data were statistically analyzed by using one-way ANOVA and Tukey's post-hoc test, as well as a multivariate analysis to test the influence of the study parameters. RESULTS: Significant differences were observed between the micromechanical properties of the tested resin cements (p < 0.05). The resin cement shade showed the highest effect on the micromechanical properties (Partial-eta squared (ηP(2))-E = 0.45, ηP(2)-HV = 0.59, ηP(2)-Cr = 0.29) of the resin cement, followed by ceramic thickness (ηP(2)-E = 0.38, ηP(2)-HV = 0.3, ηP(2)-Cr = 0.04) and ceramic shade (ηP(2)-E = 0.2, ηP(2)-HV = 0.26). CONCLUSIONS: Resin cement shade is an important factor influencing the mechanical properties of the material. Light shades of a resin cement express higher E and HV as well as lower Cr values compared with the darker ones.

Survival of porcelain laminate veneers with different degrees of dentin exposure: 2-year clinical results.

PURPOSE: To evaluate the clinical performance of porcelain laminate veneers (PLVs) after 2 years. MATERIALS AND METHODS: Twenty-eight patients were treated with 125 PLVs. The experimental variables were preparation design (incisal overlap [IO] and incisal bevel [IB]) and adhesion surface (enamel [E], enamel with minimal dentin exposure [MDE], and enamel with severe dentin exposure (SDE)]. Marginal adaptation, marginal discoloration, secondary caries, postoperative sensitivity, and patient satisfaction were assessed according to the modified United States Public Health Service criteria. Each restoration was examined for fractures and debonding. In addition, gingival tissue health by gingival plaque, bleeding, and recession was recorded. An experienced clinician evaluated the restorations at baseline and after 6, 12, and 24 months, and survival rates evaluating relative and absolute failures were calculated (p = 0.05). RESULTS: Eleven (8.8%) veneers failed, and the overall cumulative survival rate was 91.2% after 2 years of followup. IB and IO preparation designs exhibited survival rates of 94% and 85.7%, respectively, but this difference was not statistically significant (p > 0.05). PLVs bonded to SDE were more likely to fail than those bonded to E and MDE (p < 0.05). There was no significant difference between the failure rate of PLVs bonded to E and those bonded to MDE (p > 0.05). CONCLUSIONS: PLVs have high survival rates when bonded to enamel only, as well as to enamel with minimal dentin exposure. However, extensive dentin exposure should be avoided during the preparation.

Influence of ceramic thickness and type on micromechanical properties of light-cured adhesive bonding agents.

OBJECTIVE: The aim of this study was to evaluate the micromechanical properties of different adhesive bonding agents when polymerized through ceramics. MATERIALS AND METHODS: Sixty sound extracted human third molars were selected and the crowns were sectioned perpendicular to the long axis in order to obtain dentin slices to be bonded with one of the following adhesives: Syntac/Heliobond (Ivoclar-Vivadent) or Adper-Scotchbond-1XT (3M-ESPE). The adhesives were cured by using a LED-unit (Bluephase®, Ivoclar Vivadent) with three different curing times (10 s, 20 s and 30 s) under two ceramics (IPS-e.max-Press, Ivoclar-Vivadent; IPS-Empress®CAD, Ivoclar-Vivadent) of different thicknesses (0 mm, 0.75 mm, 2 mm). Thirty groups were included, each containing 60 measurements. Micromechanical properties (Hardness, HV; indentation modulus, E; and creep, Cr) of the adhesives were measured with an automatic microhardness indenter (Fisherscope H100C, Germany). Data were statistically analyzed by using one-way ANOVA and Tukey's post-hoc test, as well as a multivariate analysis to test the influence of the study parameters (SPSS 18.0). RESULTS: Significant differences were observed between the micromechanical properties of the adhesives (p < 0.05). The ceramic type showed the highest effect on HV (Partial-eta squared (η(2)) = 0.109) of the tested adhesives, while E (η(2) = 0.275) and Cr (η(2) = 0.194) were stronger influenced by the adhesive type. Ceramic thickness showed no effect on the E and Cr of the adhesives. CONCLUSIONS: The adhesive bonding agents used in this study performed well by curing through different thicknesses of ceramics. The micromechanical properties of the adhesives were determined by the adhesive type and were less influenced by ceramic type and curing time.

Effect of resin shades on opacity of ceramic veneers and polymerization efficiency through ceramics.

OBJECTIVES: The aim of this study was to assess the effect of different resin cement shades on the opacity and color difference of ceramics and to determine the polymerization efficiency of the resin cement at different shades after curing through ceramics. METHODS: Two different ceramics (IPS e.max Press and IPS Empress(®)CAD, Ivoclar Vivadent) were used for this study. A light-cured veneer luting resin (Variolink Veneer, Ivoclar Vivadent) in four different shades of HV+1, HV+3, LV-1, and LV-3 was used for the colorimetric measurements. The color and spectral reflectance of the ceramics were measured according to the CIELab color scale relative to the standard illuminant D65 on a reflection spectrophotometer (ColorEye7000A, USA). Color differences (ΔE values) and the contrast ratios (CR) of the different groups of samples were calculated. In order to analyse the polymerization efficiency of the resin cements, the micromechanical properties of the resins were measured with an automatic microhardness indenter (Fisherscope H100C, Germany). The results were analysed using one-way ANOVA and Tukey's HSD post hoc tests (SPSS 18.0). RESULTS: The one-way ANOVA test showed that the values of ΔE and CR of the different specimen groups were significantly different (p<0.05). Group 1 (20.7 ± 0.5) (IPS-CAD without resin cement) exhibited the highest and group 10 (14.8 ± 0.5) (e.max:HV+3) exhibited the lowest ΔE value. Significant differences in the micromechanical properties were identified among the tested resin cements in different shades (p<0.05). CONCLUSIONS: Resin cement shade is an important factor for the opacity of a restoration. Furthermore, the resin shade affects the micromechanical properties of the underlying resin cement.

Shear bond strength of porcelain laminate veneers to enamel, dentine and enamel-dentine complex bonded with different adhesive luting systems.

OBJECTIVES: The aim of this study was to evaluate the shear bond strength of porcelain laminate veneers to 3 different surfaces by means of enamel, dentine, and enamel-dentine complex. METHODS: One hundred thirty-five extracted human maxillary central teeth were used, and the teeth were randomly divided into 9 groups (n=15). The teeth were prepared with 3 different levels for bonding surfaces of enamel (E), dentine (D), and enamel-dentine complex (E-D). Porcelain discs (IPS e.max Press, Ivoclar Vivadent) of 2mm in thickness and 4mm in diameter were luted to the tooth surfaces by using 2 light-curing (RelyX Veneer [RV], 3M ESPE; Variolink Veneer [VV], Ivoclar Vivadent) and a dual-curing (Variolink II [V2], Ivoclar Vivadent) adhesive systems according to the manufacturers' instructions. Shear bond strength test was performed in a universal testing machine at 0.5mm/min until bonding failure. Failure modes were determined under a stereomicroscope, and fracture surfaces were evaluated with a scanning electron microscope. The data were statistically analysed (SPSS 17.0) (p=0.05). RESULTS: Group RV-D exhibited the lowest bond strength value (5.42±6.6MPa). There was statistically no difference among RV-D, V2-D (13.78±8.8MPa) and VV-D (13.84±6.2MPa) groups (p>0.05). Group VV-E exhibited the highest bond strength value (24.76±8.8MPa). CONCLUSIONS: The type of tooth structure affected the shear bond strength of the porcelain laminate veneers to the 3 different types of tooth structures (enamel, dentine, and enamel-dentine complex). CLINICAL SIGNIFICANCE: When dentine exposure is necessary during preparation, enough sound enamel must be protected as much as possible to maintain a good bonding; to obtain maximum bond strength, preparation margins should be on sound enamel.

Effects of toothbrushing with fluoride abrasive and whitening dentifrices on both unbleached and bleached human enamel surface in terms of roughness and hardness: an in vitro study.

AIM: The aim of this in vitro study was to evaluate the surface roughness and hardness of both unbleached and bleached (opalescence; 10% carbamide peroxide) human enamel brushed with water (without dentifrice), fluoride abrasive dentifrice (Colgate Total) and whitening dentifrice (Natural White). MATERIALS AND METHODS: Human enamel samples were obtained from third molars and randomly divided into five groups (n = 8): G1 - Control (brushed with water without dentifrice), G2 - Colgate Total (fluoride abrasive dentifrice), G3 - Natural White (whitening dentifrice), G4 - Opalescence (10% carbamide peroxide) and then brushed with Colgate Total, G5 - Opalescence (10% carbamide peroxide) and then brushed with Natural White. Bleaching regimen was applied according to manufacturers' instructions. The brushing process was performed with a modified Nyffenegger's brushing machine. Surface roughness was analyzed with a profilometer. Microhardness testing was performed with a Brinell hardness tester. RESULTS: Results were statistically analyzed by Kruskal-Wallis, one-way ANOVA analysis and Mann-Whitney U, Wilcoxon matched-pairs signed-ranks tests. There were significant differences in surface roughness values for all groups, which showed an increase in roughness (p < 0.05). When the bleaching treatment combined with brushing with whitening dentifrice was performed (G5), there was a significant decrease in hardness values (p < 0.05). The other groups (G1, G2, G3, G4) showed no significant hardness differences (p > 0.05). CONCLUSION: It was concluded that toothbrushing procedures increased the enamel surface roughness, and that bleaching regimen performed with cleaning treatment, through brushing with whitening dentifrice decreased hardness values. CLINICAL SIGNIFICANCE: When applied together, bleaching and cleaning treatments may alter the enamel surface roughness and hardness values.

Micromechanical properties of veneer luting resins after curing through ceramics.

The aim of this study was to assess the performance of light-cured luting resin after curing under the ceramic restoration in comparison to dual-cured luting resin, by evaluating the micromechanical properties. Two hundred seventy thin luting composite films of ca. 170 µm in thickness were prepared by using two light-cured luting resins (Variolink Veneer, Ivoclar Vivadent; RelyX Veneer, 3M ESPE) and a dual-cured luting resin (Variolink II, Ivoclar Vivadent). The composites were cured by using a LED-unit (Bluephase®, Ivoclar Vivadent) with three different curing times (10, 20, and 30 s) under two ceramics (IPS e.max Press, Ivoclar Vivadent; IPS Empress® CAD, Ivoclar Vivadent) of different thicknesses (0, 0.75, and 2 mm). Forty-five groups were included, each containing six thin films. The samples were stored after curing for 24 h at 37°C by maintaining moisture conditions with distilled water. Micromechanical properties of the composites were measured with an automatic microhardness indenter (Fisherscope H100C, Germany). For each sample, ten indentations were made, thus totalizing 60 measurements per group. Micromechanical properties of the luting resins were statistically analyzed (SPSS 17.0). Significant differences were observed between the micromechanical properties of the luting resins (p < 0.05). Variolink II showed the highest values in modulus of elasticity (E = 11 ± 0.5)* and Vickers hardness (HV = 48.2 ± 3.2)* and the lowest values in creep (Cr = 4.3 ± 0.1)* and elastic-plastic deformation (We/Wtot = 38.6 ± 0.7)* followed by RelyX Veneer (E = 6.9 ± 0.3, HV = 33 ± 2.5, Cr = 4.6 ± 0.2, We/Wtot = 41.8 ± 1.0)* and Variolink Veneer (E = 4.4 ± 0.4, HV = 20.1 ± 2.6, Cr = 5 ± 0.2, We/Wtot = 43.7 ± 1.3)*. Dual-cured luting resin expressed higher values in the micro-mechanical properties compared to the light-cured luting resins. The effect of luting resin type on the micromechanical properties of the luting resins was higher than the effect of curing time, ceramic type and ceramic thickness respectively (*The values of reference without ceramics for 30 s curing time).

Effects of in-office and at-home bleaching on human enamel and dentin: an in vitro application of Fourier transform infrared study.

In-office and at-home bleaching techniques are widely used methods for the whitening of teeth. However, the safety of these techniques has not been clarified yet. The aim of the current study is to investigate the in-office- and at-home-bleaching-induced structural and quantitative changes in human enamel and dentin at the molecular level, under in vitro conditions. The Fourier transform mid-infrared (mid-FT-IR) spectroscopic technique was used to monitor bleaching-induced structural changes. Band frequency and intensity values of major absorptions such as amide A, amide I, phosphate (PO(4)), and carbonate (CO(3)(-2)) bands, for treatment groups and control, were measured and compared. The results revealed that both procedures have negligible effects on dentin constituents. In office-bleached enamel, in addition to demineralization, a decrease in protein and polysaccharide concentrations, mineral-to-protein ratio, and the strength of hydrogen bonds around NH groups, as well as a change in protein secondary structure were observed. The protein structure changed from beta-sheet to random coil, which is an indication of protein denaturation. However, no significant variations were observed for at-home bleached enamel. The control, at-home, and in-office bleached enamel samples were differentiated with a high accuracy using cluster analysis based on FT-IR data. This study revealed that office bleaching caused deleterious alterations in the composition and structure of enamel that significantly affected the crystallinity and mineralization of the tissue. Therefore, at-home bleaching seems to be much safer than in-office bleaching in terms of molecular variations.

Effect of toothbrushing on the material loss, roughness, and color of intrinsically and extrinsically stained porcelain used in metal-ceramic restorations: an in vitro study.

PURPOSE: Because of abrasion by toothbrushing, dental materials in the oral cavity are subjected to substance loss to a different extent depending on the hardness of the material. This study investigated the color-change effect of substance loss and change of roughness resulting from toothbrushing of internally and externally stained metal ceramic. MATERIALS AND METHODS: Metal-ceramic specimens 15 mm in diameter and 2 mm thick were made. Blue colorant suspension was applied over the enamel porcelain (enamel-stained), in the body porcelain (dentin-stained), and over the opaque porcelain (opaque-stained). One group was not stained. Each group was made up of seven samples. All specimens were brushed in an experimental device. Material loss, roughness measurements, and spectrophotometric evaluations were made before and after brushing. Overall color change, chroma change, and value change were calculated with the use of the CIE-LAB uniform color scale. RESULTS: Significant substance loss as a result of brushing was observed. No significant differences between chroma changes, between value changes of different groups, or between overall color changes of dentin- and enamel-stained groups were found. The difference between overall color changes of opaque-dentin and opaque-enamel stained groups was statistically significant. CONCLUSION: Staining should be done as deeply as possible to obtain durable color appearance.