The removal of three kinds of occlusal veneers by Er: Yag laser / 华西口腔医学杂志

OBJECTIVES@#This study aimed to remove occlusal veneers of varied thicknesses and compositions by Er:Yag laser in vitro and analyze the interfacial microstructure between veneers and tooth that irradiated by laser, by which experimental evidence could be provided to support the non-invasive removal of occlusal veneerby laser.@*METHODS@#Fresh mandibular premolars extracted for orthodontic requirements were collected for tooth preparation. Three kinds of ceramic materials (Vita Suprinity, Vita Mark Ⅱ, and Upcera Hyramic) were selected to fabricate occlusal veneer with different thicknesses (1.0, 1.5, and 2.0 mm). One week later, Er:Yag laser (2.5 W and 3.5 W) was used to irradiate and remove the occlusal veneer and recorded the timespan. After the removal operation, the micro-morphologies of samples were examined by scanning electron microscope.@*RESULTS@#Upcera Hyramic veneer failed to be removed (>20 min); the operation span at 2.5 W, Vita Suprinity (96.0 s±16.0 s) was longer than Vita MarkⅡ(84.5 s±19.5 s) in the 1.0 mm group (P<0.05), and Vita Suprinity (246.5 s±13.5 s) was longer than Vita MarkⅡ(170.0 s±14.0 s) in the 1.5 mm group (P<0.05). At 3.5 W, Vita Suprinity (381.0 s±24.0 s) was longer than Vita MarkⅡ(341.5 s±26.5 s) in the 2.0 mm group.@*CONCLUSIONS@#Increasing laser power could shorten the operation span and facilitate the removal of occlusal veneers with the same thickness and composition. The occlusal veneer was sustained when insufficient laser power was applied. With the same laser power and ceramic thickness, laser penetration could interfere with the integral of the ceramic structure when the laser interacted with the bonding layer. With the same ceramic composition and laser power, the operation span and laser power increased with the thickness of the occlusal veneer. However, the laser was incapable of removing occlusal resin veneer directly.

Estabilidad cromática de una cerámica de feldespato monocromática utilizada en sistema CAD/CAM sometida a inmersión de diferentes soluciones de tinción / Color stability of a monochromatic feldspar ceramic used in CAD/CAM system immersed in different staining solutions

RESUMEN: Objetivo: Determinar la estabilidad cromática de una cerámica de feldespato monocromática utilizada en sistema CAD/CAM sometida a inmersión de diferentes soluciones de tinción. Materiales y métodos: 90 discos de cerámica feldespática monocromática, divididos en 3 grupos según solución de tinción: agua destilada, café y té. Se realizaron 3 tomas de color: el día 0, 14 y 28, con un espectrofotómetro. Para determinar la diferencia de color (ΔE*), se restó la 2da y la 1era medida para los 14 días; y la 3era y la 2da medida para los 28 días. Resultados: Los resultados se interpretaron utilizando el Índice del Departamento Nacional de Normas (NBS). La muestra inmersa en agua destilada presentó valores ΔE* 1.424 y ΔE* 1.233; la muestra en café presentó valores ΔE* 3.327 y ΔE* 3.901; la muestra inmersa en té presentó valores ΔE* 4.597 y ΔE* 5.201. Se obtuvieron diferencias significativas al comparar la estabilidad cromática en las tres soluciones de tinción a los 14 y 28 días (p<0.001). Conclusiones: Existe diferencia significativa en la estabilidad cromática de una cerámica de feldespato monocromática sometida a inmersión de diferentes soluciones de tinción. Se obtuvieron cambios de color marcados en las muestras inmersas en café y en té.

ABSTRACT: Objective: Determine the color stability of a monochromatic feldspathic ceramic used in CAD / CAM system subjected to immersion in different staining solutions. Methods and materials: 90 monochromatic feldspathic ceramic discs were divided into 3 groups according to staining solution: distilled water, coffee and tea. Three color samples were taken: on days 0, 14 and 28, with a spectrophotometer. To determine the color difference (ΔE *), the 2nd and 1st measure were subtracted for the 14 days; and the 3rd and 2nd measure for the 28 days. Results: The results were interpreted using the National Standards Department Index (NBS). The sample immersed in distilled water presented values ΔE * 1,424 and ΔE * 1,233; the sample in coffee presented values ΔE * 3,327 and ΔE * 3,901; the sample immersed in tea presented values ΔE * 4,597 and ΔE * 5,201. Significant differences were obtained when comparing the chromatic stability in the three staining solutions at 14 and 28 days (p <0.001). Conclusion: There is a significant difference in the chromatic stability of a monochromatic feldspar ceramic subjected to immersion in different staining solutions. Marked color changes were obtained in the samples immersed in coffee and tea.

Incidence of Fracture in Single Ceramic Crowns in Patients with Chronic Tooth Wear: a Clinical Follow-up / Incidencia de Fractura en Coronas Cerámicas Únicas en Pacientes con Desgaste Dental Crónico: un Seguimiento Clínico

The aim of this study was to identify the incidence of fractures in single crowns placed in individuals with chronic tooth wear. The sample selection was performed based on the evaluation of 218 patient records rehabilitated with single crowns placed by the same professional from a private clinic. After exclusion criteria, 43 individuals (18 males and 25 females) were included and a total of 112 single crowns distributed in both jaws. Three ceramic systems were evaluated: 34 feldspathic all-ceramic, 38 metal-ceramic with a core in gold electropositive alloy, and 40 In-Ceram Alumina. The intraoral photograph analysis adopted a diagnosis method of tooth wear according to the morphological variations of the teeth. Of the 112 crowns evaluated, 47 were placed in male and 65 in female patients, aged between 21 to 74 years (mean 27.5 years old). The variables gender (p = 0.83), presence of chronic tooth wear (p = 0.91), ceramic system (p = 0.24) and crown location (p = 0.86) did not present a statistically difference. However, the variables pulp vitality (p = 0.04) and survi val time (p = 0.01) presented a statistically significant difference. The evaluated ceramic systems can be considered as alternativ es of restorative material, even in individuals with clinical characteristics suggestive of chronic tooth wear.

El objetivo de este estudio fue identificar la incidencia de fracturas en coronas individuales colocadas en individuos con desgaste dental crónico. La selección de la muestra se realizó en base a la evaluación de 218 registros de pacientes rehabilitados con coronas individuales colocadas entre 1999 y 2009 por el mismo profesional de una clínica privada. Después de analizar los criterios de exclusión, se incluyeron 43 individuos (18 hombres y 25 mujeres) y un total de 112 coronas individuales distribuidas en ambas mandíbulas. Este estudio evaluó coronas hechas de tres sistemas cerámicos: 34 de cerámica totalmente feldespática, 38 de cerámica de metal con un núcleo de aleación electropositiva de oro y 40 de alúmina enceram. El análisis de la fotografía intraoral adoptó un método de diagnóstico del desgaste dental de acuerdo con las variaciones morfológicas de los dientes. De las 112 coronas evaluadas, 47 se colocaron en hombres y 65 en mujeres, con edades comprendidas entre 21 y 74 años (media de 27,5 años). Con respecto a las coronas individuales, las variables género (p = 0,83), presencia de desgaste dental crónico (p = 0,91), sistema cerámico (p = 0,24) y ubicación de la corona (p = 0,86) no presentaron una diferencia estadísticamente significativa. Sin embargo, las variables vitalidad pulpar (p = 0.04) y tiempo de supervivencia (p = 0.01) presentaron una diferencia estadísticamente significativa. Los sistemas cerámicos evaluados pueden considerarse como alternativas de material restaurador, incluso en individuos con características clínicas que sugieren desgaste dental crónico.

The effect of surface treatment and thermocycling on the shear bond strength of orthodontic brackets to the Y-TZP zirconia ceramics: A systematic review

ABSTRACT Introduction: Various surface pre-treatment methods have been adapted to optimize the bonding between the zirconia ceramics and the orthodontic brackets. Objective: This review is aimed at systematically analyzing the relevant data available in the literature, to find out the most effective and durable bonding protocol. Methods: Database search was conducted in PubMed, Scopus, and ScienceDirect, during September 2020. The review was conducted according to the PRISMA guidelines. Results: Based on the inclusion criteria, 19 articles were selected for qualitative analysis. Meta-analysis could not be performed due to the heterogeneity of the methodology among the studies. Most of the studies scored medium risk of bias. Compared to the untreated surface, surface pretreatments like sandblasting and lasers were advantageous. Primers and universal adhesive were mostly used as an adjunct to the mechanical pretreatment of the zirconia surface. In most studies, thermocycling seemed to lower the shear bond strength (SBS) of the orthodontic brackets. Conclusion: Based on this qualitative review, surface pretreatments with lasers and sandblasting can be suggested to optimize the bracket bond strength. To clarify this finding, meta-analysis is anticipated. Hence, high heterogeneity of the included studies demands standardization of the methodology.

RESUMO Introdução: Diferentes métodos de pré-tratamento da superfície foram adaptados para otimizar a colagem entre os braquetes ortodônticos e as cerâmicas de zircônia. Objetivo: A presente revisão teve como objetivo analisar, de forma sistemática, os dados relevantes na literatura, para buscar o protocolo de colagem mais efetivo e duradouro. Métodos: As buscas foram feitas em setembro de 2020, nas seguintes bases de dados: PubMed, Scopus e ScienceDirect. A revisão foi feita de acordo com as diretrizes do PRISMA. Resultados: Com base nos critérios de inclusão, 19 artigos foram selecionados para análise qualitativa. A metanálise não pôde ser feita, devido à heterogeneidade na metodologia dos estudos incluídos. A maior parte dos estudos apresentou risco de viés moderado. Comparadas às superfícies não tratadas, as superfícies com pré-tratamento usando jateamento ou laser apresentaram vantagem. Primers e adesivos universais foram mais usados como adjuntos ao pré-tratamento mecânico da superfície de zircônia. Na maioria dos estudos, a termociclagem parece ter reduzido a resistência ao cisalhamento dos braquetes ortodônticos. Conclusões: Com base nessa revisão qualitativa, os pré-tratamentos de superfície com laser e jateamento podem ser sugeridos para otimizar a resistência ao cisalhamento dos braquetes. Para esclarecer esse achado, uma metanálise é necessária. Para isso, faz-se necessária a padronização da metodologia, para lidar com a alta heterogeneidade dos estudos incluídos.

Effect of two processing techniques used to manufacture lithium disilicate ceramics on the degree of conversion and microshear bond strength of resin cement / Efeito de duas técnicas de processamento utilizadas na fabricação da cerâmica de dissilicato de lítio no grau de conversão e na resistência de união ao microcisalhamento do cimento resinoso

ABSTRACT The aim of the current study was to compare the effect of two lithium disilicate ceramic processing techniques (pressing and CAD/CAM) on the degree of conversion of resin cement when it is photoactivated and the microshear bond strength of resin cement to ceramics. Two ceramic discs were manufactured: one by the Press technique and another by CAD/CAM technique. Five Variolink Veneer resin cement samples were photoactivated through each ceramic disc and subjected to attenuated total reflectance Fourier transform infrared spectroscopy to evaluate their degree of conversion. To evaluate microshear bond strength, 20 ceramic bars were prepared: 10 using the Press technique and 10 using the CAD/CAM technique. The bars were air abraded with 50-μm Al2O3 particles, treated with 10% hydrofluoric acid for 20 s and subjected to RelyX Ceramic Primer application. Adper Scotchbond Multi-Purpose Adhesive was applied to the bars and cured for 10 s. Two 1-mm-height plastic tubes were placed on each bar and filled with Variolink Veneer resin cement. Each cylinder was cured for 20 s. Then the plastic tubes were removed and the microshear bond strength of each cylinder was tested. Data for degree of conversion (%) and microshear bond strength (MPa) were subjected to Student's t-test (α = 0.05). Both degree of conversion of resin cement photoactivated through ceramic and microshear bond strength of resin cement to ceramic were statistically higher in the group in which ceramic was prepared by CAD/CAM technique (44.74% and 22.18 MPa) than in the group in which the ceramic was prepared by the Press technique (25.71% and 19.83 MPa). The lithium disilicate ceramic processing techniques affected the degree of conversion of resin cement when it is photoactivated through the ceramics and the microshear bond strength of resin cement to ceramics.

RESUMO O objetivo do presente estudo foi comparar o efeito de duas técnicas de processamento da cerâmica de dissilicato de lítio (prensada e CAD/CAM) no grau de conversão do cimento resinoso quando fotoativado e na resistência de união ao microcisalhamento do cimento resinoso às cerâmicas. Foram fabricados dois discos de cerâmica: um pela técnica prensada e outro pela técnica CAD/CAM. Cinco amostras de cimento resinoso Variolink Veneer foram fotoativadas através de cada disco cerâmico e submetidas à espectroscopia no infravermelho por transformada de Fourier com reflectância total para avaliar seu grau de conversão. Para avaliar a resistência de união ao microcisalhamento, foram preparadas 20 barras de cerâmicas: 10 utilizando a técnica prensada e 10 utilizando a técnica CAD/CAM. As barras foram tratadas com partículas de Al2O3 (50 μm), com ácido fluorídrico a 10% por 20 s e submetidas à aplicação do RelyX Ceramic Primer. Em seguida, o adesivo multiuso Adper Scotchbond foi aplicado nas barras e fotoativado por 10 s. Dois tubos de plástico de 1 mm de comprimento foram colocados em cada barra e preenchidos com cimento resinoso Variolink Veneer. Cada cilindro foi fotoativado por 20 s. Os tubos de plástico foram removidos e a resistência de união ao microcisalhamento de cada cilindro foi testada. Os dados de grau de conversão (%) e resistência de união ao microcisalhamento (MPa) foram submetidos ao teste t de Student (α = 0,05). Tanto o grau de conversão do cimento resinoso fotoativado através da cerâmica quanto a resistência de união do cimento resinoso à cerâmica foram estatisticamente maiores no grupo em que a cerâmica foi confeccionada pela técnica CAD/CAM (44,74% e 22,18 MPa) do que no grupo em que a cerâmica foi confeccionada pela técnica prensada (25,71% e 19,83 MPa). As técnicas de processamento de cerâmica dissilicada de lítio afetaram o grau de conversão do cimento resinoso quando fotoativado através das cerâmicas e a resistência de união do microcisalhamento do cimento resinoso às cerâmicas.

Considerações Atuais Quanto as Cerâmicas Odontológicas e Seus Respectivos Sistemas de União / Current Considerations for Dental Ceramics and Their Respective Union Systems

Objetivo: avaliar as principais caracteristicas das cerâmicas odontológicas, cimentos resinosos, tratamentos de superfície e verificação dos seus devidos modos de falha, frente à literatura e suas respectivas utilizações clínicas. Material e Métodos: foi realizada uma busca bibliográfica nos principais bancos de dados de saúde PUBMED (www.pubmed.gov) e Scholar Google (www.scholar.google.com.br), no qual coletou-se trabalhos que foram publicados de 2002 a 2020. Foram inclusos estudos laboratoriais, relatos de casos, revisões sistemáticas e revisões de literatura, que fossem desenvolvidos em indivíduos vivos. Logo, foram excluídos artigos que não tratavam a respeito das caracteristicas das cerâmicas odontológicas, cimentos resinosos, tratamentos de superfície e verificação dos seus devidos modos de falha, frente à literatura e suas respectivas utilizações clínicas. Resultados: as cerâmicas podem ser classificadas em cerâmicas vítreas, cerâmicas policristalinas e as cerâmicas híbridas. Do mesmo modo que existem diferentes composições das cerâmicas e agentes de união, há também alguns protocolos de tratamento de superfície que se diferem de acordo com a escolha desses materiais. Conclusão: diversos sistemas cerâmicos estão disponíveis no mercado, fazendo com que os profissionais da área protética necessitem de uma constante reciclagem acerca das suas propriedades e indicações, visto que bons resultados não são devidos exclusivamente ao tipo de material utilizado, mas sim, à seleção do melhor material, tipo de preparo em conjunto à habilidade do profissional, cimentos resinosos, tratamentos de superfície e verificação dos seus devidos modos de falha. Nesse contexto, fazem-se necessários maiores estudos com relação às cerâmicas odontológicas e seu devido uso em um cenário clínico

Objective: to evaluate the main characteristics of dental ceramics, resin cements, surface treatments and verification of their failure modes, in relation to the literature and their respective clinical uses. Material and Methods: a bibliographic search was conducted in the main health databases PUBMED (www.pubmed.gov) and Scholar Google (www.scholar.google.com.br), in which studies published from 2002 to 2020 were collected. Laboratory studies, case reports, systematic and literature reviews, which were developed in living individuals, were included. Therefore, articles that did not deal with the main characteristics of dental ceramics, resin cements, surface treatments and verification of their failure modes, in relation to the literature and their respective clinical uses were excluded. Results: ceramics can be classified into glass-matrix ceramics, polycrystalline ceramics and hybrid ceramics. Just as there are different compositions of ceramics and bonding agents, there are also some surface treatment protocols that vary according to the choice of these materials. Conclusion: several ceramic systems are available, making professionals in the prosthetic area need a constant update about their properties and indications, since good results are not due exclusively to the type of material used, but also to the selection of the best material, type of preparation, professional's skill, resin cements, surface treatments and verification of their failure modes. In this context, further studies are needed in relation to dental ceramics and their proper clinical use

Microstructural and mechanical analysis of two CAD-CAM lithium disilicate glass-reinforced ceramics

Abstract The aim of this study was to analyze the structural, morphological and mechanical properties of two different lithium disilicate glass-reinforced ceramics for CAD-CAM systems (IPS e.max CAD and Rosetta SM). Five methodologies were used for both ceramics: microstructure (n = 2) was analyzed using x-ray diffraction (XRD); morphological properties (n = 2) were analyzed by scanning electron microscopy (SEM), with and without hydrofluoric etching; porosity (n = 3) was assessed using 3D micro-computed tomography (micro-CT); flexural strength was measured (n =1 0) using the three-point bending test; and bond strength was determined with self-adhesive resin cement (n = 10), using a microshear bond test. After performing all the tests, the data were analyzed using t-Student test and two-way ANOVA. All the tests used a significance level of α = 0.05. High peak positions corresponding to standard lithium metasilicate and lithium disilicate with similar intensities were observed for both ceramics in the XRD analysis. Morphological analysis showed that the crystalline structure of the two ceramics studied showed no statistical difference after acid etching. Additionally, no significant differences were recorded in the number or size of the pores for the ceramics evaluated. Moreover, no differences in flexural strength were found for the ceramic materials tested, or in the bond strength to ceramic substrates for the resin cements. Based on the study results, no significant differences were found between the two CAD-CAM lithium disilicate glass-reinforced ceramics tested, since they presented similar crystalline structures with comparable intensities, and similar total porosity, flexural strength and bond strength.

Leaching of Pervious Concrete Produced Using Mixed Recycled Aggregates

Abstract Waste produced by the construction sector is a problem that has grown over the last few years. Construction and demolition waste makes up about 50% by mass of the total solid waste produced in Brazil. One alternative by which to reduce this volume is recycling this material in the form of aggregates. However, it is necessary to analyze the environmental risk that the use of recycled aggregates can entail for adjacent soil and the water table. The purpose of this work was to evaluate pervious concrete samples that contained recycled aggregates and to subject them to leaching tests. The results were compared with the limits established by the Italian methodology. Aggregates with 10, 25, 50, and 100% ceramic were used, as well as a recycled concrete aggregate and a natural aggregate. With the exception of the 25% ceramic trial, all the treatments introduced chromium to the water in which they were immersed, with accumulated concentrations varying from 0.009 to 0.099 mg L-1. Cadmium was found in higher quantities, with cumulated concentrations between 0.104 and 0.417 mg L-1. Sulfate concentrations were higher after 24 h of immersion, with a maximum release of 71.7 mg L-1. The concrete made with 100% ceramic aggregate leached more chromium and sulfate than the other aggregates.

Scanning electron microscopy assessment of the load-bearing capacity of cad/cam-fabricated molar crowns

Abstract Although fiber-reinforced composites are commonly used in dental practice, whether fiber-reinforced crowns and fixed partial dentures can be used as definitive prostheses remains to be determined. This study used scanning electron microscopy to evaluate the load-bearing capacity of non-reinforced and fiber-reinforced composite (FRC) molar crowns prepared by computer-aided design/computer-aided manufacturing (CAD/CAM). The crowns were fabricated from three empirical FRC blocks, one empirical composite block, and one commercial ceramic block. The FRC resin was prepared by mixing BaO silicate particles, E-glass fiber, and dimethacrylate resin. Specimens were divided into five groups (n = 10), differing in the amounts of filler, resin, and fiber. Crowns were statically loaded until fracture. One-way analysis of variance and Tukey's post hoc multiple comparison tests were used for statistical analyses. The groups showed significant differences in load-bearing capacity; empirical bidirectional FRC resin blocks had the highest capacity, while commercial ceramic blocks had the lowest capacity. Molar crowns formed from FRC resin blocks had higher load-bearing capacity compared to non-reinforced composite resin and ceramic blocks. These results show that fiber reinforcement increased the load-bearing capacity of molar crowns.

Reporte nacional de niveles de plomo en sangre y uso de barro vidriado en población infantil vulnerable / National report of blood lead levels and lead-glazed ceramics use in vulnerable children

Resumen: Objetivo: Estimar la prevalencia de niveles elevados (≥5.0μg/dL) de plomo en sangre (PbS) y su asociación con el uso de loza de barro vidriado con plomo (LBVPb). Material y métodos: En 2018 se midió PbS capilar en una muestra representativa de niños de 1 a 4 años de edad residentes en localidades de México menores de 100 000 habitantes (Ensanut 100k). Se indagó sobre uso de LBVPb para consumo de alimentos. Para estimar su asociación con PbS, se generaron modelos logit multinomial estratificados por región. Resultados: La prevalencia de niveles elevados de PbS fue de 21.8%. En las regiones Norte, Centro y Sur las prevalencias fueron 9.8, 20.7 y 25.8%, respectivamente. La asociación con uso y frecuencia de LBVPb fue altamente significativa y diferencial por región. Conclusiones: La exposición a plomo permanece como un problema de salud pública en México, particularmente en el Centro y Sur, y está fuertemente asociada con el uso de LBVPb.

Abstract: Objective: To estimate the prevalence of elevated (≥5.0μg / dL) blood lead levels (BLL) and its association with the use of lead glazed ceramics (LGC). Materials and methods: In 2018, we measured capillary BLL in a representative sample of children 1 to 4 years old residing in Mexican localities under 100 000 inhabitants (Ensanut 100k). We inquired about use of LGC for food preparation and consumption. To estimate its association with BLL, multinomial logit models stratified by region were generated. Results: The prevalence of elevated BLL levels was 21.8%. For the North, Central and South regions, the prevalence were 9.8, 20.7 and 25.8%, respectively. The association with use and frequency of LGC was highly significant and differential by region. Conclusions: Lead exposure remains a public health problem in Mexico, particularly in the Central and South regions, and is strongly associated with the use of LGC.

Evaluation of an antibacterial orthodontic adhesive incorporated with niobium-based bioglass: an in situ study

Abstract This in situ study aimed to evaluate the antibacterial and anti-demineralization effects of an experimental orthodontic adhesive containing triazine and niobium phosphate bioglass (TAT) around brackets bonded to enamel surfaces. Sixteen volunteers were selected to use intra-oral devices with six metallic brackets bonded to enamel blocks. The experimental orthodontic adhesives were composed by 75% BisGMA and 25% TEGDMA containing 0% TAT and 20% TAT. Transbond XT adhesive (TXT) was used as a control group. Ten volunteers, mean age of 29 years, were included in the study. The six blocks of each volunteer were detached from the appliance after 7 and 14 days to evaluate mineral loss and bacterial growth including total bacteria, total Streptococci, Streptococci mutans, and Lactobacilli. Statistical analysis was performed using GLM model - univariate analysis of variance for microhardness and 2-way ANOVA for bacterial growth (p<0.05). The 20% TAT adhesive caused no difference between distances from bracket and the sound zone at 10-µm deep after 7 and 14 days. After 14 days, higher mineral loss was shown around brackets at 10- to 30-µm deep for TXT and 0% TAT adhesives compared to 20% TAT. S. mutans growth was inhibited by 20% TAT adhesive at 14 days. Adhesive with 20% TAT showed lower S. mutans and total Streptococci growth than 0% TAT and TXT adhesives. The findings of this study show that the adhesive incorporated by triazine and niobium phosphate bioglass had an anti-demineralization effect while inhibiting S. mutans and total Streptococci growth. The use of this product may inhibit mineral loss of enamel, preventing the formation of white spot lesions.

Bond strengths of various resin cements to different ceramics

Abstract This study evaluates the shear bond strength (SBS) of various resin cements to different ceramics. Composite resin cylinders of Z100 were fabricated and cemented to disks of feldspathic ceramic (Creation), leucite-reinforced feldspathic ceramic (Empress I), and densely sintered aluminum oxide ceramic (Procera AllCeram) using five resin cements: Panavia F (PAN), RelyX ARC (ARC), RelyX Unicem (RXU), RelyX Veneer, and Variolink II. SBS was measured after three days of water storage (baseline) and after artificial aging (180 days of water storage along with 12,000 thermal cycles). Failure mode of fractured specimens also was evaluated. Data were analyzed with Kruskal-Wallis and Mann-Whitney tests (α=0.05). RXU showed 1) the lowest baseline median SBS to feldspathic ceramic, which was not statistically different from PAN; 2) the lowest median baseline SBS to leucite-reinforced feldspathic and densely sintered aluminum-oxide ceramics. All cements performed similarly after aging, except for ARC (median 0.0 MPa) and PAN (median 16.2 MPa) in the densely sintered aluminum-oxide ceramic group. Resin cements perform differently when bonded to different ceramic substrates. While all test resin cements worked similarly in the long-term to feldspathic and leucite-reinforced feldspathic ceramics, only the MDP-containing resin cement provided durable bonds to densely sintered aluminum-oxide ceramic.

Penetration of bioceramic and epoxy-resin endodontic cements into lateral canals

Abstract: The aim of the present study was to assess the penetration capacity of two endodontic cements, Endosequence BC Sealer and AH Plus, in artificial lateral canals. Twenty-six two-rooted, maxillary first premolars were instrumented to size 40.06 using K3 files. In each root, six lateral canals of two diameters (0.06 and 0.10 mm) were created with a working length of 2, 4, and 6 mm. The specimens were randomly divided into two groups according to the endodontic cement to be used (Endosequence BC Sealer and AH Plus) and obturated by the single-cone technique. The specimens were imaged by digital periapical radiography and scores from 0 to 4 were attributed according to the degree of penetration by sealers into the lateral canals. Data were analyzed statistically by Kruskal-Wallis and Student-Newman-Keuls tests, and a significance level of p < 0.05 was adopted. No significant difference was observed between the two endodontic cements used to fill the simulated lateral canals (p > 0.05). The diameter of lateral canals only influenced the capacity of the Endosequence BC Sealer in filling the canals, and presented greater penetration in the lateral canals of diameter 0.10 mm (p < 0.05). We concluded that the bioceramic endodontic cement Endosequence BC Sealer presented similar ability as AH Plus to fill simulated lateral canals.

Effect of hydrofluoric acid concentration and etching time on resin-bond strength to different glass ceramics

Abstract: The objective of this study was to evaluate the effect of the hydrofluoridric acid (HF) concentration and time of acid conditioning on bond strength of three glass ceramics to a resin cement. Thus, fifty blocks (10 mm x 5 mm x 2 mm) of each ceramic (LDCAD: IPS e.max CAD; LCAD: IPS Empress CAD and LDHP: IPS e.max Press) were made and embedded in acrylic resin. The surfaces were polished with sandpaper (#600, 800, 1000, and 1200 grits) and blocks were randomly divided into 15 groups (n = 10) according to the following factors: Concentration of HF (10% and 5%), conditioning time (20 s and 60 s) and ceramic (LDCAD, LDHP, and L). After conditioning, silane (Prosil / FGM) was applied and after 2 min, cylinders (Ø = 2 mm; h = 2 mm) of dual resin cement (AllCem / FGM) were made in the center of each block using a Teflon strip as matrix and light cured for 40 s (1,200 mW/cm2). Then, the samples were thermocycled (10,000 cycles, 5/55°C, 30s) and submitted to the shear bond test (50 KgF, 0.5 mm/min). The data (MPa) were analyzed with 3-way ANOVA and Tukey's test (5%). Failure analysis was performed using a stereomicroscope (20x) and a scanning electron microscope (SEM). ANOVA revealed that the "concentration" factor (p = 0.01) and the interaction "acid concentration X ceramic" (p = 0.009) had a significant effect, however, the "ceramic" (p = 0.897) and "conditioning time" (p = 0.260) factors did not influence the results. The LDHP10%60s (10.98 MPa)aA* group presented significantly higher bond strength than LDHP10%20s (6.57 MPa)bA, LCAD5%20s (6,90 ±3,5)aB and LDHP5%60s (5.66 ± 2,9MPa)aA* groups (Tukey). Failure analysis revealed that 100% of specimens had mixed failure. In conclusion, etching with 5% HF for 20 seconds is recommended for lithium disilicate and leucite-reinforced CAD/CAM ceramics. However, for pressed lithium disilicate ceramic, 10% HF for 60 s showed significantly higher bond strength to resin cement.

Cytotoxicity and biocompatibility of a new bioceramic endodontic sealer containing calcium hydroxide

Abstract: This study evaluated the cytotoxicity and biocompatibility of a new bioceramic endodontic sealer (i.e., Sealer Plus BC) in comparison with those of MTA Fillapex and AH Plus. L929 fibroblasts were cultured and Alamar Blue was used to evaluate cell viability of diluted extracts (1:50, 1:100, and 1:200) from each sealer at 24 h. Polyethylene tubes that were filled with material or empty (as a control) were implanted in the subcutaneous tissue of rats. The rats were killed after 7 and 30 d (n = 8), and the tubes were removed for histological analysis. Parametric data was analyzed using a one-way ANOVA test, and nonparametric data was analyzed via the Kruskal-Wallis test followed by the Dunn test (p < 0.05). A reduction in cell viability was observed in the extracts that were more diluted for Sealer Plus BC when compared to that of Control and AH Plus (p < 0.05). However, the 1:50 dilution of the Sealer Plus BC was similar to that of the Control (p > 0.05). Conversely, more diluted extracts of MTA Fillapex (1:200) and AH Plus (1:100 and 1:200) were similar to the Control (p > 0.05). Histological analysis performed at 7 d did not indicate any significant difference between tissue response for all materials, and the fibrous capsule was thick (p > 0.05). At 30 d, Sealer Plus BC was similar to the Control (p > 0.05) and MTA Fillapex and AH Plus exhibited greater inflammation than the Control (p < 0.05). The fibrous capsule was thin for the Control and for most specimens of Sealer Plus BC and AH Plus. Thus, Sealer Plus BC is biocompatible when compared to MTA Fillapex and AH Plus, and it is less cytotoxic when less-diluted extracts are used.

Brittleness index and its relationship with materials mechanical properties: Influence on the machinability of CAD/CAM materials

Abstract: The aim of this study is to evaluate the machinability of four CAD/CAM materials (n = 13) assessed by brittleness index, Vickers hardness, and fracture toughness and interaction among such mechanical properties. The materials selected in this in vitro study are Feldspathic ceramic [FC], Lithium-disilicate glass ceramic [LD], leucite-reinforced glass ceramic [LR], and nanofilled resin material [RN]. Slices were made from the blocks following original dimensions 14 × 12 × 3 mm (L × W × H), using a precision slow-speed saw device and then surfaces were regularized through a polishing device. Brittleness index and fracture toughness were calculated by the use of specific equations for each one of the properties. The Vickers hardness was calculated automated software in the microhardness device. One-way Anova and Pearson's correlation were applied to data evaluation. LD obtained the highest values for brittleness index and was not significantly different from FC. LR presented statistically significant difference compared with RN, which had the lowest mean. Vickers hardness showed LD with the highest average, and no statistical difference was found between FC and LR. RN presented the lowest average. Fracture toughness showed FC and LR not statistically different from each other, likewise LD and RN. The brittleness index, considered also as the machinability of a material, showed within this study as positively dependent on Vickers hardness, which leads to conclusion that hardness of ceramics is related to its milling capacity. In addition, fracture toughness of pre-sintered ceramics is compared to polymer-based materials.

Correspondence between try-in pastes and resin cements, and color stability of bonded lithium disilicate disks

Abstract: This study investigates the color correspondence of resin cements and try-in pastes, and the color stability of bonded lithium disilicate ceramic disks. Resin composite disks were fabricated (n = 36) to serve as the background for lithium disilicate disks prepared in two thicknesses (0.5 and 1.0 mm, n = 18 each). Two brands were used for try-in and cement procedures: Variolink Veneer and AllCem Veneer. For baseline, water was applied between the ceramic disks and their respective backgrounds to achieve the control group. This set was subjected to color measurement using an intraoral measurement device (T0). The try-in was inserted between background and ceramic, and this set was subjected to color measurement (T1). After adhesive procedures, the ceramic disk was placed under cement, and color measurement was performed with uncured cement (T2) and 24 h after light-curing (T3). Each set was immersed in distilled water and thermal-cycled, with color measurement being performed after 10,000 (T4) and 20,000 (T5) cycles. Color differences were calculated by CIELab (rEab) and CIEDE2000 (rE00). Data were analyzed by two-way ANOVA for repeated measurements and Tukey's test (α=5%). There was color correspondence of try-in and resin cement for the Variolink system, regardless of the ceramic thickness (p > 0.05). For the AllCem system, the thickness significantly influenced the color measurement (p < 0.001). The Variolink system also demonstrated color stability after 20,000 thermal cycles with rEab < 3.46 and rE00 < 2.25. It was concluded that the color correspondence between a try-in and its respective cement may vary according to resin cement composition.

Fatigue survival and damage modes of lithium disilicate and resin nanoceramic crowns

Abstract Polymer-based composite materials have been proposed as an alternative for single unit restorations, due to their resilient and shock absorbing behavior, in contrast to the brittleness of ceramic materials that could result in failure by fracture. Objective: To evaluate the fatigue strength and damage modes of monolithic posterior resin nanoceramic and lithium disilicate glass ceramic crowns. Methodology: Twenty-six resin nanoceramic (RNC) and lithium disilicate glass ceramic (LD) 2 mm monolithic crowns (n=13) were cemented on composite resin replicas of a prepared tooth and subjected to cyclic load with lithium disilicate indenters for 2 million cycles. Specimens and indenters were inspected every 500,000 cycles and suspended when presenting fractures or debonding. Surviving specimens were embedded in epoxy resin, polished and subsurface damage was analyzed. Specimens presenting fractures or severe subsurface damage were considered as failures. Survival data was subjected to Fisher's exact test; damage modes were subjected to Mann-Whitney test (p<0.05). Results: There were no debonding, cohesive or catastrophic failures. Considering subsurface damage, 53.8% of RNC and 46.2% of LD crowns survived the fatigue test, presenting no statistical difference. Chief damage modes were radial cracks for RNC and inner cone cracks for LD, presenting no statistical difference. Conclusions: The results suggest that if debonding issues can be resolved, resin nanoceramic figures can be an alternative to posterior crowns. Although distinct, damage modes revealed potential to cause bulk fracture in both glass ceramic and resin nanoceramic crowns.

Quantitative image of fluorescence of ceramic and resin-cement veneers

Abstract The main of the study was quantify the effect of two ceramics with two underlying resin cements on apparent fluorescence levels. Buccal surfaces of two bovine incisors were ground flat producing one enamel and one dentin substrate. The veneers were fabricated (0.5 and 1.0 mm thickness) using two ceramics (IPSe.max Press and IPSe.max Zirpress, Ivoclar Vivadent). Veneers were cemented using either light-cured (Variolink II, Ivoclar Vivadent) or self-adhesive dual (Rely X U200, 3M ESPE) cement. The layered Control group materials had no cement application. Semi-quantitative fluorescence image analysis (Matlabs software, Matworks) involved processing the images as captured under each daylight (DL, Gretagmacbeth) and ultraviolet illuminants (UVA, Sylvania) within a neutral-gray lightbox (Macbeth Spectral Light). Statistical analysis of the quantitative fluorescence values was performed using two-way ANOVA and Tukey's test (p < 0.05). The e.max Zirpress on the dentin substrate produced greater fluorescence (p < 0.05) when subjected to UV illumination and more fluorescence (p < 0.05) than e.max Press in both cement groups. Light-cured cement produced higher (p < 0.05) fluorescence than the dual-cement with e.max Press on enamel under UV illumination. The fluorescence for e.max Press on the dentin substrate was greater (p < 0.05) than for e.max Zirpress using dual self-adhesive cement subjected to daylight illumination. Thus, it is possible to conclude that the combination of ceramic and cement produce definite, significant effects on the apparent fluorescence, vital quality for restorative dentistry.

Influence of activation mode, fatigue, and ceramic interposition on resin cements' diametral tensile strength

Abstract This study evaluated the influence of activation modes, on Diametral Tensile Strength (DTS) of dual cured resin cements subjected to a Mechanical Fatigue test (MF). Four dual-cured resin cements (RelyX UNICEM [U], RelyX ARC [A], ENFORCE [E] and Nexus 2 [N]) were activated by three different curing modes as follows: Self-Curing (SC), Dual Cure activation with photoactivation executed directly (DC) and Dual Cure activation with Photoactivation Through Porcelain (DCTP). After 24 hours, half of the sample was subjected to 30.000 fatigue cycles at 1 Hz frequency and 12 N load. Then, all specimens were subjected to DTS test in Instron Universal Testing Machine and data were analyzed by three-way ANOVA and Tukey's Test (5%). The results of DTS test means (MPa) and standard deviation, for each cement factor activated by SC, DC and DCTP was respectively: U (28.12 ± 5.29; 37.44 ± 6.49 and 40.10 ± 4.39), A (49.68 ± 8.42; 55.12 ± 5.16 and 63.43 ± 6.92), E (49.12 ± 3.89; 56.42 ± 8.88 and 56.96 ± 6.45) and N (61.89 ± 11.21; 59.26 ± 9.47 and 62.56 ± 10.93). Turkey's test indicated that DC is related to the highest DTS values; Nexus 2 DTS remained the same independently of activation mode and that the Porcelain disk interposition enhanced DTS only for RelyX ARC the ANOVA statistical test indicated that MF didn't alter the DTS values for all experimental groups. MF results clinical implication is that all cements tested exhibited, in an immediate loading, good cross linked bonds quality.