Do preheated composite resin or adhesive resin layer strengthen the feldspar ceramic?

STATEMENT OF PROBLEM: Preheated composite resin and adhesive coating have been recommended as luting agents for ceramic veneers; however, information about the mechanical behavior of feldspathic porcelain veneers after using these methods is still limited. PURPOSE: The purpose of this in vitro study was to evaluate the influence of the use of preheated composite resin or an adhesive resin layer on the strengthening of a feldspathic porcelain. MATERIAL AND METHODS: Feldspathic porcelain disks were fabricated (N=210), etched (10% hydrofluoric acid for 90 seconds), and bonded according to resin-based luting agents (30 per group) for the biaxial flexural strength tests: photopolymerized resin cement, flowable composite resin, preheated composite resin, with or without previous adhesive coating. Characteristic strength and Weibull modulus were calculated. The viscosity of the luting agents was measured by using isothermal analyses. Finite element analysis simulated the flexural test. Fractographic and bonded interfaces were observed. RESULTS: The use of preheated composite resin led to the lowest stress levels in the feldspathic porcelain veneers. However, it did not increase the ceramic strengthening compared with other luting agents, as higher values were observed with flowable composite resin (P<.05). The use of an adhesive resin layer had no significant effect on ceramic strengthening when associated with preheated composite resin or resin cement (P>.05). Preheated composite resin presented the highest viscosity and led to incomplete filling of the porcelain surface irregularities. Failures originated on the ceramic surface subjected to tensile stress and were typically associated with pores at the ceramic-luting agent interface. CONCLUSIONS: The use of preheated composite resin or an adhesive resin layer did not have a positive effect on strengthening feldspathic porcelain.

Fatigue resistance of simplified CAD-CAM restorations: Foundation material and ceramic thickness effects on the fatigue behavior of partially- and fully-stabilized zirconia.

OBJECTIVE: To evaluate the fatigue failure load, number of cycles until failure and survival probability of partially (PSZ) and fully-stabilized (FSZ) polycrystalline zirconia disc shaped specimens with different thicknesses adhesively cemented onto foundations with distinct elastic moduli. METHODS: Disc-shaped specimens (n = 15, Ø = 10 mm; thickness = 1.0 and 0.7 mm) of CAD/CAM PSZ and FSZ blocks were adhesively cemented onto discs with different foundations (Ø = 10 mm; thickness = 2.0 mm) made from epoxy resin, composite resin or Ni-Cr metallic alloy. The cemented assemblies were subjected to fatigue testing using a step-stress approach (600-2800 N; step-size of 100 N; 10,000 cycles per step; 20 Hz) and the data was submitted to specific statistical tests (α = 0.05). Fractography and finite element (FEA) analyzes were also performed. RESULTS: PSZ and FSZ presented higher fatigue failure load, number of cycles until failure and survival probabilities when cemented onto metallic alloy. All PSZ specimens survived the fatigue test when cemented onto Ni-Cr alloy (100% probability of survival at 2800 N; 230,000 cycles). Regardless of the foundation type, PSZ had better fatigue behavior than FSZ. For thickness, thinner PSZ restorations underperformed when bonded to softer foundations, while FSZ groups and groups bonded to metallic foundations had no statistical difference. SIGNIFICANCE: The foundation material strongly influences the fatigue performance of PSZ and FSZ restorations, which presented mechanical behavior improvements when bonded to a metallic foundation. PSZ restorations showed better fatigue behavior than FSZ, while the ceramic thickness only influenced PSZ restorations bonded to softer foundations.

Bond strength and quality of bond interface of multifilament fiberglass posts luted onto flat-oval root canals without additional dentin wear after biomechanical preparation.

STATEMENT OF PROBLEM: An intraradicular retainer formed by multiple independent glass fiber filaments was developed aiming to allow better adaptation in flattened root canals; however, the performance of the new posts is unclear. PURPOSE: The purpose of this in vitro study was to compare the bond strength (BS) and adhesive interface quality achieved in flattened root canals restored with conventional glass fiber posts (CFPs) and multifilament glass fiber posts (MFPs). MATERIAL AND METHODS: The distal roots of mandibular molars with long oval root canals were endodontically treated, and the obturation material was removed and assigned to 2 groups (n=11) according to the type of retainer used: CFP (WhitePostDC#0.5; FGM) or MFP (CometTail#4; Synca). The posts were cemented with self-adhesive resin cement. The specimens were sectioned (2 slices per third). The most cervical slice in each third was used to evaluate the BS, while the adhesive interface in the apical slices was analyzed by scanning electron microscopy. BS data were analyzed by using a multilevel generalized linear model, and adhesive interface SEM data were analyzed by using a multilevel ordinal logistic regression model (α=.05). RESULTS: Multilevel regression showed a statistically significant difference for the "type of retainer" factor (P=.001; CFP 2.61 ±1.30>MFP 1.59 ±1.54). No statistically significant differences were found for the "root thirds" factor (P=.346) or for the interaction of both factors (P=.114). The failure pattern was predominantly mixed or adhesive for CFP and adhesive to dentin for MFP. A better adaptation of the restorative material was observed in the cervical third for CFP and in the apical third for MFP (P<.001). CONCLUSIONS: MFP resulted in lower BS values than CFP, with a higher prevalence of adhesive failures to dentin and better adaptation of the adhesive interface in the apical third.

Acceptance of systematic reviews as Master/PhD theses in Brazilian graduate programs in dentistry.

OBJECTIVE: This study aimed to evaluate whether a master and PhD thesis in Brazilian graduate programs in dentistry can be based on a systematic review (SR). METHODS: In this cross-sectional study, we surveyed the coordinators of Brazilian graduate programs in dentistry using a self-administered questionnaire including questions about whether an SR meets requirements for approval of a master or PhD thesis, instructions regarding how to use an SR as the method for a master or PhD thesis, and reasons and barriers that SRs were not recognized as acceptable for a master or PhD thesis. The responses were analyzed descriptively, and tables and graphs were created to summarize the data. RESULTS: Among 101 graduate programs invited to participate in the study, 38 (37.6%) returned the questionnaire. Over three-quarters of surveyed programs (n = 30, 78.1%) answered that SRs, in whole or in part, meet the criteria for a master or PhD thesis. Likewise, most programs answered that a master or PhD thesis could be exclusively based on an SR (n = 28, 73.7%). The same number of programs pointed out that one possible reason for not recognizing SRs as a master or PhD thesis is either the lack of SR expertise among committee members (n = 28, 73.7%) or the lack of adequate training of candidates in SR methodology (n = 26, 68.4%). CONCLUSIONS: SRs are well accepted as a master or PhD thesis by Brazilian graduate programs in dentistry. Educational initiatives should be encouraged to promote understanding of SR methodology and increase acceptance among graduate programs worldwide.

Stable Resin Bonding to Y-TZP Ceramic with Air Abrasion by Alumina Particles Containing 7% Silica.

PURPOSE: To evaluate the influence of new air-abrasion powders with different silica concentrations (silica-coated aluminum oxide) and aging on the bond strength between composite cement and Y-TZP ceramic. MATERIALS AND METHODS: Ceramic slices (7 x 6.3 x 2 mm3) were randomly allocated into 8 groups (n = 20) considering different surface treatments (SiC: silica-coated aluminum oxide particles; AlOx: aluminum oxide particles; 7% Si and 20% Si: experimental powders consisting of 7% and 20% silica-coated of AlOx respectively) and aging (baseline: 24 h at 37°C in water; aged: 90 days at 37°C in water + 12,000 thermal cycles). A blinded researcher performed the air-abrasion procedure for 10 s (identical parameters for all groups). Composite resin cylinders (Ø = 3 mm) were cemented onto the silanized ceramic surfaces, light cured, and subjected to shear bond-strength testing (wire loop Ø = 0.5 mm). The topography of the powders and air-abraded surfaces was analyzed using SEM and atomic force microscopy (AFM). The elemental composition of the powders and air-abraded surfaces was analyzed with energy dispersive spectroscopy (EDS), and surface wetting of the air-abraded surfaces was also determined by contact-angle measurements. RESULTS: Under baseline conditions, all groups presented similar bond strengths, but only SiC and 7% Si yielded unaltered bond strength after aging. SiC and 7% Si presented lower contact angles. All groups presented similar surface topographies. The silica content was also similar among groups, except for AlOx. CONCLUSION: 7% Si and SiC presented similar bond strength and better bonding performance after aging than AlOx and 20% Si. A higher silica concentration was not able to promote stable adhesion of composite cement after aging.

Obtaining optimal esthetics with veneered zirconia and lithium disilicate frameworks on substrates of different colors.

OBJECTIVE: This study sought to describe the clinical and laboratory procedures and to discuss aspects involved in obtaining satisfactory esthetics on substrates presenting different colors. CLINICAL CONSIDERATIONS: This case report describes the clinical and laboratory procedures for obtaining an optimal esthetic result using different ceramic framework materials veneered with feldspathic ceramic over substrates of different colors. Zirconia frameworks were used for darkened substrates and were reinforced with lithium disilicate for substrates with minimal discoloration. The same feldspathic veneering ceramic was applied to provide similar translucency and color for favorable esthetics. CONCLUSIONS: The materials explored in the present case report presented favorable aesthetic results in masking darkened substrates. CLINICAL SIGNIFICANCE: Clinicians should consider the condition and color of the substrate when selecting the restorative material for masking such a condition.

Surface treatments of a glass-fiber reinforced composite: Effect on the adhesion to a composite resin.

PURPOSE: To compare the effect of different surface treatments (pre-treatments and bonding agents) on the bond strength between glass-fiber post and composite resin, and the topographic alterations of the treated post surface. METHODS: Thirty-six glass-fiber blocks (12mm×10mm×8mm) were specifically manufactured for this study and randomly assigned into 12 groups considering two factors: 'pre-treatments' (-cleaning with 70% alcohol; air-abrasion with silica-coated aluminum oxide particles; 35% hydrogen peroxide) and type of 'bonding agent' (no bonding agent; application of Monobond Plus; RelyX Ceramic Primer; Single Bond Universal). After that, 6 cylindrical templates (1mm high×1mm Ø) were fixed on each block, filled with composite resin (n=18) and light-cured. Specimens were stored under 37°C for 24h and microshear tests (wire loop Ø=0.2mm) were performed. Topographic, roughness and failure analyses were also performed. RESULTS: Different surface pre-treatments led to different topographic and roughness alterations; a higher surface alteration was noted after silica particles air-abrasion, while a slight surface alteration in the hydrogen peroxide group and a smooth pattern were observed in the cleaning group. The factors 'pre-treatments' (p<0.05), 'bonding agent' (p<0.05) and their interaction (p<0.05) influenced the bond strength. Silica coating, apart from bonding agent application, or Single Bond Universal application without pre-treatment promoted the highest bond values. The main failure type was adhesive at the resin-post interface. CONCLUSIONS: In terms of pre-treatments, silica coating promotes the best bonding performance, but pre-treatments can be dispensable when applying Single Bond Universal.

Fatigue performance of adhesively cemented glass-, hybrid- and resin-ceramic materials for CAD/CAM monolithic restorations.

OBJECTIVE: To evaluate the fatigue failure load, number of cycles until failure, and survival probability of adhesively cemented materials with different microstructures (glass-, hybrid- and resin-ceramic) used to manufacture CAD/CAM monolithic restorations. METHODS: Disc-shaped specimens (n=15; Ø=10mm; thickness=1.0mm) were produced from CAD/CAM blocks as follows: feldspathic (FEL); leucite (LEU); lithium disilicate (LD); zirconia-reinforced lithium silicate (ZRLS); polymer-infiltrated ceramic network (PICN); and resin nanoceramic (RNC). Adhesive cementation was performed onto epoxy discs (dentin analogue- Ø=10mm; thickness=2.5mm). The cemented assemblies were subjected to fatigue testing using a step-stress approach (400N-2200N; step-size of 200N; 10,000 cycles per step; 1.4Hz). Fatigue data were analyzed using Kaplan-Meier and Mantel-Cox (log-rank) tests (p<0.05) and Weibull statistical analysis. Fractographic analysis was also performed. RESULTS: All RNC specimens survived the fatigue test (100% probability of survival at 2200N; 100,000 cycles) and presented occlusal deformation in response to loading, while all other tested materials failed in distinct loading steps with radial cracks starting from the bonding surface. LD (1146.7N; 47,333) and ZRLS (1013.3N; 40,666) materials obtained the highest fatigue failure loads and cycles until failure, meanwhile all PICN specimens failed during the first step (0% probability of survival at 400N; 10,000). FEL had similar Weibull modulus to LD and ZRLS and higher than LEU for both load and number of cycles outcomes. SIGNIFICANCE: The microstructure of adhesively cemented glass-, hybrid- and resin-ceramic CAD/CAM restorative materials influence their response during fatigue testing, which aids in suggesting the best clinical indications.

Effect of Surface Coating on Bond Strength between Etched Feldspar Ceramic and Resin-Based Luting Agents.

This study evaluated adhesive protocols (silane, silane and unfilled resin, and universal adhesive) of bond strength between feldspar ceramic and resin-based luting agents (RBLAs). Thirty ceramic disks were embedded into acrylic resin, polished, etched, and randomly divided into 6 groups: S-RC: silane (S) and light-cured resin cement (RC) (RelyX Veneer; 3M ESPE); SB-RC: S followed by bond (B) (Clearfil SE Bond, Kuraray) and RC; UA-RC: universal adhesive (UA) (Single Bond Universal; 3M ESPE) and RC; flowable composite resin (F) was used on groups S-F, SB-F, and UA-F, and luting agent cylinders were built. The response variables (n=20) were microshear bond strength (MPa), characteristic strength (σ0 , MPa), and Weibull modulus (m). The RC groups presented similar bond strengths regardless of whether or not bond was used. The S-F group with only silane application showed the highest bond strength, while the universal adhesive showed the lowest bond strength. The reliability was only affected in the UA-RC group, which was lower than the S-F group. Silane application is fundamental since the universal adhesive only decreased the bond strength between the feldspar ceramic and the RBLAs. Overall, the use of unfilled resin did not positively influence bond strength.

Mechanical reliability, fatigue strength and survival analysis of new polycrystalline translucent zirconia ceramics for monolithic restorations.

This study characterized the mechanical properties (static and under fatigue), the crystalline microstructure (monoclinic - m, tetragonal - t and cubic - c phase contents) and the surface topography of three yttrium-stabilized zirconia (YSZ) materials with different translucent properties, before and after aging in an autoclave (low temperature degradation). Disc-shaped specimens were produced from second generation (Katana ML/HT - high-translucent) and third generations (Katana STML - super-translucent and UTML - ultra-translucent) YSZ ceramics (Kuraray Noritake Dental Inc.), following ISO 6872-2015 guidelines for biaxial flexural strength testing (final dimensions: 15 mm in diameter and 1.2 ±â€¯0.2 mm in thickness), and then subjected to the respective tests and analyses. ML was mainly composed of tetragonal crystals, while STML and UTML presented cubic content. Aging increased the monoclinic content for ML and did not affect STML and UTML. Topographical analysis highlights different grain sizes on the ceramic surface (UTML > STML > ML) and aging had no effect on this outcome. Weibull analysis showed the highest characteristic strength for ML both before and after aging, and statistically similar Weibull moduli for all groups. ML material also obtained the highest survival rates (ML > STML > UTML) for both fatigue strength and number of cycles to failure. All fractures originated from surface defects on the tensile side. Third generation zirconia (Katana STML and UTML) are fully stabilized materials (with tetragonal and cubic crystals), being totally inert to the autoclave aging, and presented lower mechanical properties than the second-generation zirconia (Katana ML - metastable zirconia).

Influence of remaining coronal thickness and height on biomechanical behavior of endodontically treated teeth: survival rates, load to fracture and finite element analysis.

Objective To evaluate the effect of restorative strategy (fiber post vs cast post and core), coronal height (0 mm vs 2 mm) and thickness (higher than 1 mm vs lower than 1 mm) on survival rate, fracture resistance and stress distribution. Material and Methods Seventy-two bovine teeth were cleaned and allocated in six groups (n = 12). Twenty-four teeth were sectioned at 13 mm length (no remaining coronal structure) and forty-eight were sectioned at 15 mm (2 mm remaining coronal structure). Half of the forty-eight had remaining coronal thickness lower than 1 mm and the other half had thickness higher than 1 mm. All root canals were prepared at 10 mm (luting length), fiber posts were cemented in thirty-six specimens and cast post and core in other thirty-six. All teeth were restored with metallic crowns. Specimens were submitted to 1.5 million cycles (100 N, 45°, 10 Hz at 2 mm below incisal edge) and evaluated at each 500,000 cycles to detect failures. Specimens that survived were submitted to load to fracture test. Bidimensional (Rhinoceros® 4.0) models were obteined survival data submitted to Kaplan-Meier (α=0.05) analysis and load to fracture values submitted to ANOVA and Tukey tests (α=0.05). Results Groups without remaining coronal structure showed survival rates lower than other groups (p=0.001). ANOVA showed higher values of load to fracture for groups with coronal thickness higher than 1 mm (p=0.0043). Finite element analysis showed better stress distribution in groups with remaining coronal structure and restored with fiber post. Conclusion Specimens without remaining coronal structure have lower survival rates. Specimens with remaining structure lower than 1 mm and without coronal structure support the same load to fracture value independently of the restorative strategy.

The effect of hydrofluoric acid concentration on the fatigue failure load of adhesively cemented feldspathic ceramic discs.

OBJECTIVE: This study investigated the influence of hydrofluoric acid (HF) etching at different concentrations on the fatigue failure load of adhesively cemented feldspathic ceramic discs (Vita Mark II). Besides, their effect on the micromorphology of ceramic surface was investigated. METHODS: Eighty ceramic discs (ϕ=10 mm; thickness=1.5 mm) were cemented to epoxy supporting discs (ϕ=10 mm; thickness=2.0mm) using different surface conditioning methods (n=20): nonetched control (CTRL), or etched for 60s with different HF concentrations: 1% (HF1), 5% (HF5), or 10% (HF10). All the ceramic discs received a silane application (Monobond Plus). The epoxy discs were etched with 10% HF for 60s and received a primer coating (Multilink Primer A+B). Adhesively cementation was performed (Multilink Automix), and the assemblies (ceramic discs/epoxy discs) were subjected to cyclic loads in water by a staircase approach (500,000 cycles; 20Hz; initial load=290N; step size=30N). Fatigue failure load data were analyzed using 1-way ANOVA and post-hoc Tukey's tests (α=.05). RESULTS: Mean failure load of the HF5 group (255.0±23.0N) was significantly lower; HF1 group (301.7±71.0N) presented intermediate values, and the highest values were achieved in CTRL (351.7±13.4N) and HF10 (341.7±20.6N) groups. All the failures were radial cracks starting from the bonding surface. SIGNIFICANCE: In terms of fatigue failure load, etching with 1% and 5% HF had a deleterious effect on the fatigue behavior of an adhesively cemented feldspathic ceramic, while 10% HF had no negative influence.

Influence of remaining coronal thickness and height on biomechanical behavior of endodontically treated teeth: survival rates, load to fracture and finite element analysis

Abstract Objective To evaluate the effect of restorative strategy (fiber post vs cast post and core), coronal height (0 mm vs 2 mm) and thickness (higher than 1 mm vs lower than 1 mm) on survival rate, fracture resistance and stress distribution. Material and Methods Seventy-two bovine teeth were cleaned and allocated in six groups (n = 12). Twenty-four teeth were sectioned at 13 mm length (no remaining coronal structure) and forty-eight were sectioned at 15 mm (2 mm remaining coronal structure). Half of the forty-eight had remaining coronal thickness lower than 1 mm and the other half had thickness higher than 1 mm. All root canals were prepared at 10 mm (luting length), fiber posts were cemented in thirty-six specimens and cast post and core in other thirty-six. All teeth were restored with metallic crowns. Specimens were submitted to 1.5 million cycles (100 N, 45°, 10 Hz at 2 mm below incisal edge) and evaluated at each 500,000 cycles to detect failures. Specimens that survived were submitted to load to fracture test. Bidimensional (Rhinoceros® 4.0) models were obteined survival data submitted to Kaplan-Meier (α=0.05) analysis and load to fracture values submitted to ANOVA and Tukey tests (α=0.05). Results Groups without remaining coronal structure showed survival rates lower than other groups (p=0.001). ANOVA showed higher values of load to fracture for groups with coronal thickness higher than 1 mm (p=0.0043). Finite element analysis showed better stress distribution in groups with remaining coronal structure and restored with fiber post. Conclusion Specimens without remaining coronal structure have lower survival rates. Specimens with remaining structure lower than 1 mm and without coronal structure support the same load to fracture value independently of the restorative strategy.

The effect of internal roughness and bonding on the fracture resistance and structural reliability of lithium disilicate ceramic.

OBJECTIVE: To evaluate the effect of internal roughness and bonding on the load to failure and structural reliability (Weibull analysis) of a lithium disilicate-based glass ceramic under different testing scenarios. METHODS: IPS e.max CAD blocks (Ivoclar Vivadent AG) were shaped into cylinders (N=100), crystalized according to the manufacturer's instructions, and randomly assigned into two surface conditions: (1) polished surface (600-grit SiC polish papers), and (2) a roughened surface (air-abrasion with 50µm Al2O3). Two assemblies were investigated: a ceramic disc isolated (to isolate the effect of roughness); and a simplified tri-layer setup simulating the restoration of a posterior tooth (ceramic+cement+epoxy resin) to evaluated the influence of bonding isolated and the associated effect of both factors. Four different scenarios were tested: (1) isolated disc under static load (n=10); (2) disc bonded to an epoxy resin substrate and tested under a static load (n=10); (3) disc bonded and tested under fatigue (n=20); and (4) simulated-bonding tested statically (n=10). The data of load to failure were submitted to One-way ANOVA and Weibull analysis. RESULTS: At a non-bonded scenario (isolated disc and simulated-bonding) a polished internal surface presented a higher characteristic strength. However, when bonding was present this difference became inexistent. No difference was found in terms of structural reliability (Weibull moduli) among the groups. FEA analysis shows that with bonding the tensile stress is better distributed, while in a non-bonded scenario higher tensile stresses occur at the bonding interface. SIGNIFICANCE: A rough internal surface impacted deleteriously the mechanical properties of lithium disilicate ceramic when it was not properly bonded to the substrate. However, bonding to the substrate appeared to play a more significant role in the fracture resistance than internal roughness.

Fatigue limit of monolithic Y-TZP three-unit-fixed dental prostheses: Effect of grinding at the gingival zone of the connector.

OBJECTIVES: To determine the fatigue limits of three-unit monolithic zirconia fixed dental prosthesis (FDPs) before and after grinding of the gingival areas of connectors with diamond burs. MATERIAL AND METHODS: FDPs were milled from pre-sintered blocks of zirconia simulating the absence of the first mandibular molar. Half of the specimens were subjected to grinding, simulating clinical adjustment, and all of them were subjected to glazing procedure. Additional specimens were manufactured for roughness analysis. FDPs were adhesively cemented onto glass-fiber reinforced epoxy resin abutments. Fatigue limits and standard deviations were obtained using a staircase fatigue method (n=20, 100,000 loading cycles/5Hz). The initial test load was 70% of the mean load-to-fracture (n=3) and load increments were 5% of the initial test load for both the control and ground specimens. Data were compared by Student's T-test (α≤0.05). RESULTS: Both the control and ground groups exhibited similar values of load-to-fracture and fatigue limits. Neither the surface treatments nor ageing affected the surface roughness of the specimens. CONCLUSIONS: The damage induced by grinding with fine-grit diamond bur in the gingival area of the connectors did not decrease the fatigue limit of the three-unit monolithic zirconia FDP.