Evaluation of the ceramic laminate veneer-tooth interface after different resin cement excess removal techniques.

OBJECTIVES: To compare, in vitro, resin cement excess removal techniques at the veneer-tooth interface. MATERIALS AND METHODS: Anterior human teeth were restored with ceramic veneers and randomly divided according to the following techniques (n = 10): removal of excess resin cement with brush and dental floss, followed by light-curing with Valo (Group 1) or Elipar (Group 2) for 1 min and 40 s; tack-curing with Valo (Group 3) or Elipar (Group 4) for 1 s; and tack-curing with Valo (Group 5) or Elipar (Group 6) for 5 s. The tack-curing was followed by removal of excess with probe and dental floss and light-curing for 1 min and 40 s. The area of excess resin cement (mm2) was measured in micro-CT images using AutoCAD program. The failures at the cervical margin in the X, Y, and Z axes (µm) of greater value were measured using the DataViewer program. The specimens were submitted to microleakage with 2% basic fuchsin. RESULTS: According to the Kruskal-Wallis and multiple comparison test, the highest area of excess resin cement was found in Group 1 (5.06 mm2), which did not differ statistically from Groups 2 (3.70 mm2) and 5 (2.19 mm2). Groups 2, 3 (1.73 mm2), 4 (1.14 mm2), and 5 (2.18 mm2) did not differ statistically. Group 6 (0.77 mm2) obtained the lowest value, which did not differ statistically from Groups 3 and 4. According to the Kruskal-Wallis and Dunn test, there was no significant difference in failures in X (p = 0.981), Y (p = 0.860), and Z (p = 0.638) axes and no significant difference in microleakage (p = 0.203) among the groups. CONCLUSIONS: Tack-curing for 1 s or 5 s, followed by removal of excess resin cement using a probe and a dental floss, tended to result in a lower amount of excess material around the margin. CLINICAL RELEVANCE: The technique used for resin cement excess removal influences the amount of excess leaved at the veneer-tooth interface. Tack-curing for 1 s or 5 s is recommended to mitigate the excess resin cement.

Is additional silane application necessary for a new silane-containing universal adhesive to bond to glass ceramics?

OBJECTIVE: To evaluate the in vitro influence of prior silane application on the microshear bond strength (µSBS) of Scotchbond Universal Plus to glass ceramic. MATERIALS AND METHODS: Thirty blocks of lithium disilicate ceramic were etched with hydrofluoric acid for 20 s and distributed into Group 1 (no silane and no adhesive), Group 2 (adhesive), Group 3 (silane + adhesive). Three cylinders of resin cement were made on each ceramic block. Five blocks (n = 15 cylinders) were subjected to the µSBS test after 24 h, and the other five blocks (n = 15 cylinders) were tested after 6 months of water storage. RESULTS: According to two-way ANOVA, followed by Tukey's test, the means of µSBS (MPa), denoted by different letters, show significant differences (p < 0.05): after 24 h-Group 1 (31.7)B, Group 2 (43.3)A, and Group 3 (31.3)B; after 6 months-Group 1 (14.8)B, Group 2 (33.6)A, and Group 3 (30.3)A. After 6 months of storage, there was a significant decrease in µSBS for Groups 1 and 2, along with an increase in adhesive failures across all groups. CONCLUSIONS: Prior application of silane did not increase the µSBS between Scotchbond Universal Plus and ceramic, and there was degradation at the bond interface over time. CLINICAL SIGNIFICANCE: Prior application of a silane agent is not necessary when using Scotchbond Universal Plus for bonding to glass ceramics. Regardless of the prior application of silane, there is degradation at the bond interface over time.

In vitro comparison of one-step, two-step, and three-step polishing systems on the surface roughness and gloss of different resin composites.

OBJECTIVES: This laboratory study evaluated the effect of three polishing systems on the surface roughness and gloss of resin composites. MATERIALS AND METHODS: Thirty specimens (6 mm Ø × 8 mm) were fabricated from each of three resin composites: Z 350 XT (nanofill), Harmonize (nanohybrid), and Estelite Omega (supranonofill). All specimens were photopolymerized using a multi-peak LED curing unit (VALO-Standard mode), having a exitance irradiance of approximately 1000 mW/cm2 against a polyester strip (PS). 2 mm was then removed from the irradiated end (finished) using #320 abrasive paper (F). Specimens were then randomly polished (P) using a one-step (1S) (OneGloss), two-step (2S) (EVE Diacomp Twist Basic CA), or 3-step (3S) (Astropol P) system (n = 10). For PS, F, and P groups, surface roughness (Ra) was measured using a surface roughness tester, and surface gloss was measured with a glossmeter. For each specimen, the percent recovery to the PS value (%R) of surface roughness and surface gloss were calculated. Data were analyzed using two-way ANOVA, followed by Tukey's test. Surface roughness and gloss values were submitted to Pearson's correlation test (α = 0.05). All statistical testing was performed using a pre-set alpha of 0.05. RESULTS: The interaction term [resin composite × polishing system] was significant for both surface roughness (p = 0.001) and gloss (p = 0.0001). For all resin composites, the 2S and 3S systems provided a higher %R of surface roughness and gloss compared to those of the 1S system. There was a negative correlation between surface roughness and gloss, but only a few combinations showed strong correlations. CONCLUSIONS: The 2S and 3S polishing systems provided surfaces having greater smoothness and gloss compared to the 1S system. The ability to recover surface roughness and gloss was dependent on type of resin composite filler classification. CLINICAL SIGNIFICANCE: The 3S and 2S polishing systems were more effective in achieving PS values than was the 1S system for all tested resin composites. However, individual polishing systems performed differently depending on type of resin composite.

Examining the effects of acid etching duration on the bond strength between two CAD/CAM materials and one composite resin.

This study aimed to evaluate the effect of three hydrofluoric acid (HF) etching periods on the micro-tensile bond strength between two CAD-CAM ceramic systems [Vita Suprinity (VS) and feldspathic CEREC blocs (CB)] and a composite resin. The ceramics were categorized into six groups based on the surface conditioning protocol used, as follows: G1: CB-HF 5% for 20 s; G2: CB-HF 5% for 40 s; G3: CB-HF 5% for 60 s; G4: VS-HF 5% for 20 s; G5: VS-HF 5% for 40 s; G6: VS-HF 5% for 60 s. Scotchbond Universal was applied onto the pretreated ceramic surfaces and covered with Filtek Z350 XT composite resin. After 24 h, the specimens were cut into microbars (n = 16) and a micro-tensile bond strength test (µTBS) was carried out. An optical microscope was used to examine the fractured microbars. The results showed statistically significant differences between the factors tested (p < 0.01). Moreover, the mean MPa of G1(17.27), G2(13.03), G3(12.82), G4(15.83), G5(21.66), and G6(14.50) was seen to significantly differ. The predominant failure type observed was adhesive, and all three periods of HF etching produced satisfactory bonding between the composite resin and CB. An etching time of 40 s provided the highest µTBS value for VS.

Fracture load of CAD/CAM ultrathin occlusal veneers luted to enamel or dentin.

OBJECTIVES: To evaluate, in vitro, the fracture load of IPS e.max CAD occlusal veneers at thicknesses of either 0.3 or 0.6 mm luted to enamel or dentin. MATERIALS AND METHODS: Fifty human molars were randomly distributed into five groups (n = 10): G1 - healthy teeth (control); G2-0.3-mm-thick veneers luted to enamel; G3-0.6-mm-thick veneers luted to enamel; G4-0.3-mm-thick veneers luted to dentin; and G5-0.6-mm-thick veneers luted to dentin. After the luting procedures, the specimens were immersed in distilled water at 37°C for 24 hours and then subjected to mechanical loading (106 cycles at 200 N load). The specimens were subjected to a fracture load test in a universal testing machine. Two-way ANOVA and Tukey's test (α = 0.05) were used to analyze data. RESULTS: Only the thickness factor was significant (P = .002). Values of fracture load followed by distinct letters represent significant differences (P < .05): G1 (3204 N ± 730)ab ; G2 (3144 N ± 729)ab ; G3 (2489 N ± 606)b ; G4 (3591 N ± 776)a ; and G5 (2770 N ± 598)ab . CONCLUSION: IPS e.max ultrathin occlusal veneers luted to enamel or dentin obtained fracture load comparable to that of the healthy tooth. CLINICAL SIGNIFICANCE: IPS e.max CAD ultrathin occlusal veneers at 0.3 or 0.6-mm-thick seem to provide good perspectives in relation to the clinical use.

Properties of Acrylic Resin For CAD/CAM: A Systematic Review and Meta-Analysis of In Vitro Studies.

PURPOSE: This systematic review and meta-analysis of in vitro studies compared the prepolymerized acrylic resin used for CAD/CAM complete denture manufacturing versus the heat-polymerized acrylic resin for conventional complete dentures in terms of surface roughness, wettability, hardness and flexural strength. MATERIALS AND METHODS: An electronic search was performed in the PubMed, Embase, LILACS and Web of Science databases, without language or date restrictions. Gray literature and manual search tools were also used. The systematic review was carried out by two researchers independently, following the inclusion criteria: in vitro studies testing the CAD/CAM acrylic resin with a control group of heat-polymerized acrylic resin which compared at least one of the four material properties above. The meta-analysis was performed separately for each property, using a random effect model. RESULTS: Of the 914 studies found by means of search strategies, 698 were selected for the systematic review. After applying the eligibility criteria, only 17 articles were selected for the qualitative analysis in the systematic review; among these, 14 were included in the quantitative meta-analysis. The CAD/CAM prepolymerized acrylic resin in blocks had similar properties when compared to heat-polymerized acrylic resin in almost all outcome measures, with the exception of a statistically significant reduction in surface roughness. CONCLUSIONS: Based on the findings of this systematic review and meta-analysis, equally satisfactory results can be expected from dental prosthesis manufactured by the CAD/CAM system when compared to conventional ones, with the additional potential of reducing the pigmentation and attached microorganisms due to the reduced surface roughness of the prepolymerized resin.

Marginal adaptation and microleakage of a bulk-fill composite resin photopolymerized with different techniques.

The purpose of this study was to investigate the marginal adaptation and microleakage of SonicFill composite with different photopolymerization techniques. Class II cavities were prepared in 40 premolars and divided into groups according to the photopolymerization technique (n = 10): G1:1200 mW/cm2 for 20 s; G2:1200 mW/cm2 for 40 s; G3:Soft-start with 650 mW/cm2 for 5 s and 1200 mW/cm2 for 15 s; G4:Soft-start with 650 mW/cm2 for 10 s and 1200 mW/cm2 for 30 s. The cavities were restored with OptiBond FL adhesive and SonicFill. Epoxy resin replicas were obtained before and after thermocycling. The occlusal and cervical margins were analyzed with scanning electron microcopy and expressed as the percentage of continuous margins (%CM). The specimens were submitted to microleakage with silver nitrate. ANOVA and Tukey's test revealed that the %CM at the linguo-occlusal margin for group 1 (83.19%) was significantly different from groups 2, 3 and 4, which had values over 95%. At the cervical margin, there was no statistically significant difference between the groups. After thermocycling, there was a significant decrease in %CM. The predominant score of microleakage was 1 in enamel and 3 in dentin. The SonicFill composite led to gap formation and microleakage, especially in the dentin at the cervical margin, regardless of the photopolymerization technique employed.

The effect of milling and postmilling procedures on the surface roughness of CAD/CAM materials.

PURPOSE: The aim of this study was to evaluate the surface roughness and analyze the surface topography of five different CAD/CAM ceramics and one CAD/CAM composite resin for CEREC after milling and postmilling procedures. MATERIALS AND METHODS: Blocks of the ceramics Mark II, IPS Empress CAD, IPS e.max CAD, Suprinity and Enamic, and blocks of the composite resin Lava Ultimate were milled at CEREC MCXL. Ten flat samples of each material were obtained. The surface roughness (Ra) test was performed before and after milling, crystallization, polishing, and glaze when indicated, followed by SEM and AFM analysis. Data were submitted to one-way ANOVA with repeated measures and the Tukey HSD test (α = 0.05). RESULTS: The milling step significantly increased the roughness of all the tested materials (P < .05). Lithium-based ceramics (IPS e.max CAD and Suprinity) were more suitable to roughness than the other tested materials (P < .05). CONCLUSIONS: The polishing methods were able to reduce roughness to baseline values, except for lithium-based ceramics. Glaze reduced significantly the roughness of lithium-based ceramics without a difference from the baseline. SEM and AFM images revealed that glazed surfaces are smoother than polished surfaces. CLINICAL SIGNIFICANCE: All hard-milling CAD/CAM materials, that is, fully sintered, should be only hand polished. The glaze step can be suppressed resulting in time saving. However, the glaze step in soft-milling lithium disilicate is imperative.

Different Strategies to Bond Bis-GMA-based Resin Cement to Zirconia.

PURPOSE: To evaluate the effect of different bonding strategies on short- and long-term bis-GMA-based resin cement bond strengths to zirconia. MATERIALS AND METHODS: One hundred twenty samples of fully-sintered zirconia (Prettau Zirconia) were sandblasted and randomly distributed into 5 groups (n = 24): UA: Scotchbond Universal Adhesive; SZP: Signum Zirconia Bond I + II; ZPP: Z-Prime Plus; EXP: MZ experimental primer; CO: no primer application (control). After performing these surface treatments, translucent tubes (0.8 mm diameter and 1.0 mm height) were placed on the zirconia specimens, and bis-GMA-based cement (Duo-Link) was injected into them and light cured. Specimens were tested for microshear bond strength either 24 h or 6 months (m) after water storage (37°C) and surfaces were characterized by SEM and EDX. Two-way ANOVA and Tukey's post-hoc test (p < 0.05) were used to evaluate bond strength results. RESULTS: The mean bond strengths (MPa ± SD) were: UA=14.6 ± 4.7a (24 h); 16.0 ± 4.8a (6 m); SZP = 14.0 ± 5.4ab (24 h); 11.9 ± 2.6ab (6 m); ZPP=8.0 ± 1.8b (24 h); 8.6 ± 3.3b (6 m); EXP = 1.2 ± 0.5c (24 h); 0.6 ± 0.7c (6 m); CO=1.0 ± 1.2c (24 h); 1.3 ± 1.2c (6 m). Bonding strategy significantly influenced bond strength (p = 0.0001), but storage time did not (p = 0.841). Groups UA and SZP showed a homogeneous layer covering the zirconia surface. In these groups, EDX demonstrated the presence of phosphorus. Group ZPP resulted in a nonhomogeneous layer, exposing the zirconia substrate underneath. EXP application resulted in an undetectable layer. CONCLUSION: Water storage did not affect resin cement bond strengths to zirconia irrespective of the surface treatment. Bis-GMA-based resin cement bond strengths to zirconia are affected by specific bonding strategies.

Clinical Evaluation of Indirect Composite Resin Restorations Cemented with Different Resin Cements.

PURPOSE: To clinically evaluate the performance of indirect composite resin restorations cemented with conventional and self-adhesive resin cements over a 12-month period. MATERIALS AND METHODS: Ten patients fulfilled all the inclusion criteria. Twenty-four composite resin restorations were performed using an indirect technique and cemented with a resin cement (RelyX ARC) or a self-adhesive resin cement (RelyX U100). Two independent evaluators analyzed the restorations using modified USPHS criteria after periods of two weeks and 6 and 12 months. Statistical significance between the cements at each timepoint was evaluated with the Wilcoxon test and between timepoints with the Mann-Whitney test, both at a significance level of 5%. Fisher's exact test was used to assess the occurrence of absolute failures. RESULTS: No statistically significant differences were found between the groups at the same timepoint nor between groups at different timepoints. The only significant difference was found for color match for both groups after 12 months. CONCLUSION: After 12 months, indirect composite resin restorations cemented with self-adhesive resin cement performed similarly to those cemented with conventional resin cement.

Surface roughness and maintenance of surface sealants for resin composites after toothbrushing.

PURPOSES: (1) To evaluate in vitro the surface roughness of a resin composite covered with three surface sealants and submitted to simulated toothbrushing for different periods; (2) Verify, through scanning electron microscopy (SEM), the presence of surface sealants after simulated toothbrushing; and (3) To evaluate whether the type of dentifrice influences the maintenance of the surface sealant. The study hypothesis was that neither variable would influence the surface roughness of the composite and the maintenance of the surface sealant. METHODS: 108 specimens were prepared with the resin Amelogen Plus, and divided into six groups (n = 18) according to the type of surface sealant [Fortify (F), BisCover LV (B) and Permaseal (P)] and toothpaste [Total 12 Clean Mint (CT) and Colgate Total 12 Professional Whitening (PW)]. The samples were subjected to brushing cycles, simulating periods of 6, 12, 18, and 24 months. After each period, the surface roughness of the samples was measured. An additional group of 48 samples was prepared for SEM analysis. The results were analyzed by ANOVA with three fixed variables (sealants, time and toothpaste) and by Tukey's test (α = 0.05). RESULTS: BisCover had the lowest mean surface roughness (0.06 µm) compared with the sealants Fortify (0.09 µm) and Permaseal (0.08 µm), which were not statistically different. Fortify, at 12 months of brushing, had the highest mean roughness (0.13 µm). The mean roughness for the dentifrice CT was lower (0.07 µm) when compared with PW (0.08 µm) and was statistically different. Roughness increased up to 12 months of simulated brushing (0.04 µm, 0.08 µm and 0.11 µm), decreasing from the 18th month (0.08 µm) to the 24th month of brushing (0.07 µm). None of the sealants was observed (with SEM) to be completely removed from the resin at 24 months of brushing.

Strengthening effect of horizontally placed fiberglass posts in endodontically-treated teeth restored with direct resin composite.

PURPOSE: To assess the fracture strength of cavity preparations, directly restored with resin composite, with and without the presence of fiberglass posts with different diameters. METHODS: 84 extracted third molars were embedded in acrylic resin and divided into six groups (n = 14 per group): healthy (H); cavity preparation (P); cavity preparation + endodontic treatment (PE); PE + resin composite (R); PE + R + 2 horizontally transfixed fiberglass posts 1.1 mm in diameter (PERP1); PE + R + 2 fiberglass posts 1.5 mm in diameter (PERP2). The MOD cavity preparations were standardized with their width corresponding to 2/3 of the buccolingual distance and occlusogingival depth of 4 mm, with 2 mm remaining above the cemento-enamel junction. Endodontic treatments were performed in the PE, R, PERP1 and PERP2 groups. The buccal surface received two demarcations to create orifices for placement of the PERP1 and PERP2 posts. Once the fiberglass posts were placed, the teeth were restored with resin composite. In group R, only resin composite was used. After 24 hours, the teeth were subjected to the fracture toughness test on a universal testing machine. A 10 KN load cell and crosshead speed of 1 mm/minute was used until fracture occurred. After testing, the teeth were inspected for the type of fracture classified as: pulpal floor fracture (AP) or cuspal fracture (CP). RESULTS: The data were subjected to ANOVA and Tukey's test (P < 0.05%), demonstrating a statistical difference between groups: H 3830NA; P 778ND; PE 572.93ND; R 1782NC; PERP1 2988NB; PERP2 3100NAB. The fracture pattern was similar between the tested groups, showing 50% of fracture for cusps and pulpal floor.

The influence of postpouring time on the roughness, compressive strength, and diametric tensile strength of dental stone.

STATEMENT OF PROBLEM: The optimum time after pouring a dental impression before removing the dental cast is unknown with regard to the strength and roughness of the stone. Setting times and the commercial products used are important variables. PURPOSE: The purpose of this study was to evaluate the effect of postpouring time on the surface roughness, compressive strength, and diametric tensile strength of Type IV dental stone. MATERIAL AND METHODS: A total of 270 specimens were prepared from 3 commercial brands of dental stone (Durone, Fuji Rock, and Tuff Rock). Surface roughness, compressive strength, and diametric tensile strength were assessed at 1 hour, 24 hours, and 7 days after pouring. Specimens 6 mm in diameter and 3 mm in height were produced for roughness and diametric tensile strength tests. Specimens 3 mm in diameter and 6 mm in height were used to measure compressive strength. The results were analyzed with the general linear model and Tukey honestly significant difference test (α=.05). RESULTS: The surface roughness measured for the different types of dental stone tested varied from 0.3 µm (Durone, 1 hour) to 0.64 µm (Tuff Rock, 7 days). The diametric tensile strength ranged from 3.94 MPa (Tuff Rock, 1 hour) to 9.20 MPa (Durone, 7 days). The compressive strength varied from 26.67 MPa (Durone, 1 hour) to 65.14 MPa (Fuji Rock, 7 days). CONCLUSIONS: Surface roughness (P=.005), diametric tensile strength (P=.001), and compressive strength (P=.001) increased significantly with time after pouring. The commercial brand used affected roughness (P=.001), diametric tensile strength (P=.004), and compressive strength (P=.001). Tuff Rock exhibited the highest surface roughness. The highest diametric tensile strength values were recorded for Durone and Fuji Rock. Fuji Rock exhibited the highest compressive strength.

Effect of resin cements and aging on cuspal deflection and fracture resistance of teeth restored with composite resin inlays.

PURPOSE: To evaluate the influence of resin cements and aging on cuspal deflection, fracture resistance, and mode of failure of endodontically treated teeth restored with composite resin inlays. MATERIALS AND METHODS: Seventy-two maxillary premolars were divided into 6 groups: 1: sound teeth as control (C); 2: preparations without restoration (WR); 3: inlays luted with RelyX ARC (ARC); 4: inlays luted with RelyX Unicem (RLXU); 5: inlays luted with Maxcem Elite (MCE); 6: inlays luted with SeT (ST). Groups 2 to 6 received mesio-occlusal-distal preparations and endodontic treatment. Stone casts were made for groups 3 to 6. Composite resin inlays were built over each cast and luted with the resin cements. A 200-N load was applied on the occlusal aspect and the cuspal deflection was measured using a micrometer before and after 500,000 cycles of fatigue loading (200 N; 500,000 cycles). The specimens were then submitted to an axial load until failure. RESULTS: The median cuspal deflection (µm) and median fracture resistance (N) were calculated and statistically analyzed using Kruskal-Wallis and Mann-Whitney tests (p < 0.01). Values followed by the same letter represent no statistically significant difference. Cuspal deflection before cyclic loading: C = 3 µma; ARC = 4 µmab; RLXU= 5 µmab; MCE = 21 µmb; ST = 51 µmbc; WR = 69 µmc. Cuspal deflection after cyclic loading: ARC = 6 µma; RLXU = 19 µmab; MCE = 33 µmb; ST = 62 µmb. Fracture resistance in N: C = 1902a; ARC = 980b; RLXU = 670c; MCE = 533c; ST = 601c; WR = 526c. According to the Wilcoxon test, there was no statistical difference between the cuspal deflection before and after cyclic loading only for ARC (p = 0.015). There was a predominance of recovery fractures for the restored groups. CONCLUSION: Composite resin inlays luted with RelyX ARC maintained cuspal deflection stability and showed higher fracture resistance of the teeth than did inlays luted with the other cements tested.

Effect of polyacrylic acid on the interface and bond strength of self-adhesive resin cements to dentin.

PURPOSE: To examine the influence of 11.5% polyacrylic acid pretreatment on the interface and bond strength of self-adhesive resin cements (Maxcem Elite, RelyX Unicem, SeT) to dentin. MATERIALS AND METHODS: Fifty-six third molars were randomly divided into seven groups: RelyX ARC as control (ARC), RelyX Unicem (RLXU), Maxcem Elite (MCE), SeT (ST), polyacrylic acid+RelyX Unicem (RLXU-P), polyacrylic acid+Maxcem Elite (MCE-P), and polyacrylic acid+SeT (ST-P). Resin composite blocks were luted to flat dentin. After storage in distilled water for 24 h, sticks with a cross-sectional area of ca 0.80 mm2 were obtained (n = 24 per group) and submitted to a microtensile bond strength (µTBS) test in a universal testing machine at a crosshead speed of 0.5 mm/min. Two sets from each group were sectioned mesiodistally in the center of the crown and observed with a scanning electron microscope at 4000X magnification. RESULTS: The mean results of the µTBS test (MPa) followed by the same letter do not differ statistically significantly according to ANOVA and Tukey's post-hoc test (p < 0.05): ARC = 24.19 (± 6.90)a, RLXU-P = 23.12 (± 6.18)a, MCE-P = 13.09 (± 5.87)b, RLXU = 10.23 (± 2.88)b,c, and MCE = 8.14 (± 4.63)c. All SeT specimens failed during the cutting procedure. The hybrid layer was not observed for the self-adhesive resin cements, and resin tags were observed for RelyX Unicem and Maxem Elite when dentin was pretreated with polyacrylic acid. CONCLUSION: Pretreatment with 11.5% polyacrylic acid was effective for bonding RelyX Unicem and Maxcem Elite to dentin.

Influence of resin cements on cuspal deflection and fracture load of endodontically-treated teeth restored with composite inlays.

OBJECTIVES: To evaluate the influence of resin cements on cuspal deflection, fracture load and failure mode of endodontically-treated teeth restored with composite resin inlays. MATERIALS AND METHODS: Forty maxillary premolars were randomly divided into four groups: G1 (sound teeth, control), G2 (RelyX ARC), G3 (RelyX Unicem) and G4 (Maxcem Elite). The teeth from groups 2, 3 and 4 received mesial-occlusal-distal preparations and endodontic treatments. Impressions were taken with vinyl polysiloxane and poured using type IV die stone. Inlays with Z250 composite resin were built over each cast and luted with the resin cements. A 200-N load was applied on the occlusal surface and the cuspal deflection was measured using a micrometer. The specimens were then subjected to an axial load until failure occurred. The resulting failure mode was analyzed. RESULTS: The means for cuspal deflection (µm) and fracture load (N) followed by the same letter represent no statistically significant difference based on ANOVA and Tukey's test (p < 0.05). Cuspal deflection: G1 = 4.7 (± 1.7)(a), G2 = 12.0 (± 8.9)(a), G3 = 39.0 (± 27.0)(b) and G4 = 56.8 (± 18.2)(b). Fracture load: G1 = 1982 (± 893)(a), G2 = 690.9 (± 225.5)(b), G3 = 679 (± 193.6)(b) and G4 = 465.5 (± 121.6)(b). G1 presented cusp fractures only at the cement-enamel junction (CEJ). There was a high frequency of cusp fractures below the CEJ in G2, G3 and G4. CONCLUSIONS: Composite resin inlays luted with resin cements do not recover the strength of sound teeth. However, teeth restored with composite resin inlays and luted with RelyX ARC can withstand mechanical fatigue longer before failure occurs than those luted with RelyX Unicem and Maxcem Elite.

Partial Ceramic Veneer Technique for Challenging Esthetic Frontal Restorative Procedures.

Frontal darkened teeth have shown to be one of the most challenging treatments for esthetic dentistry in recent years. This case report, along with a 30-month follow-up, describes the application of a partial ceramic veneer, restricted to the mid-cervical third region, made in the upper left central incisor darkened by trauma. The procedure consisted of maintenance of the entire incisal face, as well as esthetic and morphological rehabilitation of the smile line with veneers and ultra-thin partial ceramic veneers. The planning process was thoroughly elaborated by photographs, study models, a virtual smile designed, diagnostic waxing, and reproduction in the patient's mouth through mock-up. Following, dental home bleaching, esthetic gingival contouring, and minimally invasive tooth preparation were performed. Two types of glass ceramics (lithium disilicate and feldspathic) were used in different regions due to the peculiar characteristics of resistance, finishing, and polishing. According to the present case report, preparing a cervical partial ceramic veneer is an innovative, viable, and safe approach to maintaining the incisal portion of the tooth preserved and setting a detailed tooth morphology/color. The application of partial ceramic veneer provides incisal edge preservation and simplifies the reproduction of the adjacent tooth characteristics, avoiding multiple esthetic appointments.

Are Universal Adhesives Effective for Bonding to Zirconia in the Long Term?

Background: The bond capacity of universal adhesives should be comparable to a specific primer for zirconia. Thus, this study evaluated the bond strength to zirconia of four universal adhesives and a zirconia primer over long-term storage. Materials and Methods: The surfaces of 75 samples of zirconia were sandblasted with 50 µm aluminum oxide particles and then divided into groups (n = 15): G1 - Single Bond Universal (SBU); G2 - All Bond Universal; G3 - Peak Universal Bond; G4 - Ambar Universal (AU), and G5 - Z-Prime Plus (ZP). A cone of resin composite was constructed on the applied materials. The samples were submitted to a tensile bond strength test after 24 h using a universal testing machine. Then, the remaining materials were removed from the sample surfaces, and the surfaces were polished and sandblasted again as previously described to obtain the same groups. These new samples were stored in distilled water at 37°C for 12 months and then submitted to a tensile bond strength test. The data were analyzed by two-way analysis of variance and Tukey's test (α =0.05). Results: The material factor (P = 0.001) and the storage factor (P = 0.001) were significant, and the interaction was not significant (P = 0.117). According to Tukey's test, bond strength mean values (in MPa) followed by distinct letters were significantly different. After 24 h, G5 = 21.12 A, G1 = 20.55 A, G4 = 19.19 AB, G2 = 14.22 B, and G3 = 8.44 C. After 12 months, G1 = 7.37 A, G5 = 5.61 AB, G4 = 4.97 B, G2 = 3.32 C, and G3 = 1.93 D. After 12 months of storage, all groups' bond strength significantly decreased. Conclusions: SBU and AU had bond strengths comparable to ZP after 24 h. No material resisted water degradation.

Fracture Load of Monolithic CAD/CAM Ceramic Crowns Placed on Different Implant Abutments.

PURPOSE: To evaluate the fracture load of monolithic, single-tooth implant-supported crowns cemented on solid or Ti-base (Variobase C) abutments. MATERIALS AND METHODS: Besides abutment types (solid and Ti-base abutments), two ceramic systems (IPS e.max CAD and Zirconia inCoris ZI) and two occlusal thicknesses (0.5 and 1.5 mm) were also investigated in this study. In total, eight groups (n = 8) with 64 maxillary second premolar crowns were fabricated. All the crowns were cemented with resin cement, and the screw accesses in Ti-base groups were sealed with composite resin. After mechanical cycling, the specimens were submitted to fracture load test with the maximum force recorded in Newtons (N). Three-way analysis of variance (ANOVA) and Tukey post hoc test were used for statistical analyses (α = .05). RESULTS: Both the abutment type (P = .0001) and the ceramic system (P = .0001) significantly affected the results. Screw-access channels reduced the fracture load of crowns by half compared to those cemented on solid abutments. The 1.5-mm and 0.5-mm zirconia crowns placed on solid abutments had similar highest fracture loads, while the e.max CAD groups positioned on Ti-base abutments showed significantly lower values compared with other groups. CONCLUSION: The screw access reduces the resistance of crowns supported by Ti-base abutments compared to crowns cemented on solid abutments. The inCoris ZI showed a higher fracture load than the IPS e.max CAD regardless of the abutment type and thickness.

Effect of gastric acid on the surface roughness and bacterial adhesion of bulk-fill composite resins.

The purpose of this in vitro study was to evaluate the effect of gastric acid on the surface roughness and biofilm formation of bulk-fill composite resins. Twenty-seven samples of each composite resin were obtained: G1: Filtek Z250 XT (Z250), G2: Filtek Bulk Fill (FTK), G3: Tetric N-Ceram Bulk Fill (TTC), and G4: Aura Bulk Fill (AUR). The samples were quantitatively analyzed for surface roughness (Ra) using a roughness tester (n=15) and for biofilm formation (Cn) by the counting of colony-forming units (CFUs/mL) (n=9) in three different moments: after polishing (Ra0 and Cn0), after gastric acid immersion (Ra1 and Cn1), and after gastric acid and simulated tooth brushing (Ra2 and Cn2). Qualitative analysis through surface topography (n=3) was evaluated by scanning electron microscopy (SEM). Ra values were subjected to two-way repeated measures ANOVA, followed by Tukey's test. Cn values were subjected to Kruskal-Wallis analysis, followed by multiple comparisons analysis (α=0.05). Z250 and FTK showed significant increases in surface roughness at Ra1. There were fewer CFUs/mL on TTC and AUR in relation to those of Z250 and FTK for Cn0, Cn1 and Cn2. The SEM images showed that gastric acid increased the formation of cracks, exposure of fillers and micro cavities for all composite resins. After tooth brushing, the topographical changes were more evident but did not influence biofilm formation. The gastric acid promoted both degradation of the surfaces and bacterial adhesion for all composite resins.