Evaluation of five CAD/CAM materials by microstructural characterization and mechanical tests: a comparative in vitro study.

BACKGROUND: Polymer infiltrated ceramics and nano-ceramic resins are the new restorative materials which have been developed in order to enhance the adverse properties of glass-matrix ceramics and resin composites. The aim of the present in vitro study was to evaluate the characteristics of various CAD/CAM materials through mechanical, microstructural, and SEM analysis. METHODS: Five test groups (n = 22) were formed by using the indicated CAD/CAM blocks: VITA Enamic (VITA Zahnfabrik), Lava Ultimate (3 M ESPE), IPS e.max CAD (Ivoclar Vivadent), IPS Empress CAD (Ivoclar Vivadent), and VITA Mark II (VITA Zahnfabrik). Two specimens from each test group were used for XRD and EDS analysis. Remaining samples were divided into two subgroups (n = 10). One subgroup specimens were thermocycled (5 °C to 55 °C, 30s, 10,000 cycles) whereas the other were not. All of the specimens were evaluated in terms of flexural strength, Vickers hardness, and fracture toughness. Results were statistically analyzed using two-way ANOVA, one-way ANOVA, Tukey's HSD, and Student's t tests (α = .05). Fractured specimens were evaluated using SEM. RESULTS: The highest Vickers microhardness value was found for VITA Mark II (p < .001), however flexural strength and fracture toughness results were lowest conversely (p < .05). IPS e.max CAD was found to have the highest flexural strength (p < .001). Fracture toughness of IPS e.max CAD was also higher than other tested block materials (p < .001). Lava Ultimate and VITA Enamic's mechanical properties were affected negatively from thermocycling (p < .05). Microhardness, flexural strength, and fracture toughness values of Lava Ultimate and VITA Enamic were found to be similar to VITA Mark II and IPS Empress CAD groups. CONCLUSIONS: It should be realised that simulated aging process seem to affect ceramic-polymer composite materials more significantly than glass ceramics.

The Effect of Resin Cement Type and Thermomechanical Aging on the Retentive Strength of Custom Zirconia Abutments Bonded to Titanium Inserts.

PURPOSE: The purpose of this study was to investigate the effect of resin cement type on the retentive strength of custom zirconia abutments bonded to titanium inserts. MATERIALS AND METHODS: Sixty implant (4.3 mm diameter and 11.5 mm length) and custom zirconia abutment (15 mm height and 2 mm wall thickness) pairs were used to form six groups (n = 10 each). Three different resin cements were used to bond the zirconia abutments and titanium inserts: Panavia F 2.0, Zirconite, and Multilink Hybrid Abutment. Control groups and thermomechanically aged groups were formed. Specimens were subjected to tensile test to failure, and the retention values were analyzed by two-way analysis of variance (ANOVA). RESULTS: Two-way ANOVA showed a significant effect of the cement type and thermomechanical aging (P < .05). Regardless of the cement, control groups showed significantly (P < .05) higher retentive strength than the thermomechanically aged groups. Comparing the resin cements, the retentive strength of Zirconite, aged or not, was higher than that of Panavia F 2.0 and Multilink Hybrid Abutment; no significant differences between the latter two cements were found. In the Zirconite group, adhesive failure occurred mostly between the titanium and the resin cement. In the Panavia F 2.0 and Multilink Hybrid Abutment groups, adhesive failure between the zirconia and the resin cement was observed. CONCLUSION: Resin cement type had an effect on the retentive strength of custom zirconia abutments bonded to titanium inserts. Thermomechanical aging had a negative effect on the retentive strength. Zirconite adhesively bonded to the zirconia surface of the custom abutment. Differences were noted in adhesive failure types among the cements.

Evaluation of ISO 4049: water sorption and water solubility of resin cements.

The aim of this study was to evaluate the water sorption and solubility test design of ISO 4049 for resin cements. Sorption and solubility of six dual-curing resin cements [RelyX Unicem 2 Automix (RUN), Multilink Speed CEM (MLS), Panavia SA Plus (PSA), RelyX Ultimate (RUL), Multilink Automix (MLA), and Panavia V5 (PV5)] were analyzed by storage in distilled water after dual-curing. In addition, sorption and solubility during thermal cycling were assessed with self-cured and dual-cured specimens. After water storage, all cements revealed sorption in the range of 30 µg mm-3 except for PV5, for which sorption was markedly lower (mean ± SD = 20.8 ± 0.4 µg mm-3 ). Solubility values were negative for RUN and RUL (-2.1 ± 0.08 µg mm-3 and -1.9 ± 0.13 µg mm-3 , respectively). All other cements attained positive values in the range of 0.4-0.8 µg mm-3 . Thermal cycling effects were more pronounced. The assessment of water sorption according to ISO 4049 provides reliable results. Solubility results must be interpreted with care because absorbed water may distort the values.

Adhesives for fixed orthodontic bands.

BACKGROUND: Orthodontic treatment involves using fixed or removable appliances (dental braces) to correct the positions of teeth. It has been shown that the quality of treatment result obtained with fixed appliances is much better than with removable appliances. Fixed appliances are, therefore, favoured by most orthodontists for treatment. The success of a fixed orthodontic appliance depends on the metal attachments (brackets and bands) being attached securely to the teeth so that they do not become loose during treatment. Brackets are usually attached to the front and side teeth, whereas bands (metal rings that go round the teeth) are more commonly used on the back teeth (molars). A number of adhesives are available to attach bands to teeth and it is important to understand which group of adhesives bond most reliably, as well as reducing or preventing dental decay during the treatment period. OBJECTIVES: To evaluate the effectiveness of the adhesives used to attach bands to teeth during fixed appliance treatment, in terms of:(1) how often the bands come off during treatment; and(2) whether they protect the banded teeth against decay during fixed appliance treatment. SEARCH METHODS: The following electronic databases were searched: Cochrane Oral Health's Trials Register (searched 2 June 2016), Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 5) in the Cochrane Library (searched 2 June 2016), MEDLINE Ovid (1946 to 2 June 2016) and EMBASE Ovid (1980 to 2 June 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: Randomised and controlled clinical trials (RCTs and CCTs) (including split-mouth studies) of adhesives used to attach orthodontic bands to molar teeth were selected. Patients with full arch fixed orthodontic appliance(s) who had bands attached to molars were included. DATA COLLECTION AND ANALYSIS: All review authors were involved in study selection, validity assessment and data extraction without blinding to the authors, adhesives used or results obtained. All disagreements were resolved by discussion. MAIN RESULTS: Five RCTs and three CCTs were identified as meeting the review's inclusion criteria. All the included trials were of split-mouth design. Four trials compared chemically cured zinc phosphate and chemically cured glass ionomer; three trials compared chemically cured glass ionomer cement with light cured compomer; one trial compared chemically cured glass ionomer with a chemically cured glass phosphonate. Data analysis was often inappropriate within the studies meeting the inclusion criteria. AUTHORS' CONCLUSIONS: There is insufficient high quality evidence with regard to the most effective adhesive for attaching orthodontic bands to molar teeth. Further RCTs are required.

Clinical performance of aesthetic restorative materials in primary teeth according to the FDI criteria.

AIM: The purpose of this study is to evaluate the clinical performance of three different restorative materials in primary teeth according to the FDI criteria. MATERIALS AND METHODS: Resin-modified glass ionomer cement, compomer and composite resin restorations (n=93) were made in 31 patients. The restorations were clinically evaluated at baseline, 6th, 12th and 18th month with the FDI criteria. RESULTS: The cumulative survival rate after 18 months was found to be 90.3% for resin modified glass ionomer cement restorations, 100% for compomer restorations and 80.6% for composite resin restorations. Statistically significant increase in surface roughness, colour mismatch, anatomic form loss and marginal deterioration were detected in resin- modified glass ionomer group (p<0.05). The most frequent reason for restoration failure in composite resin group was restoration fractures. CONCLUSIONS: The resin-modified glass ionomer restorations necessitates close follow-up because of the risk of increase in surface roughness, changes in colour and loss in anatomic form and marginal adaptation. The clinical performance of compomer restorations is superior to resin-modified glass ionomer and composite resin restorations in primary teeth.

Bond durability of different resin cements to caries-affected dentin under simulated intrapulpal pressure.

OBJECTIVE: To evaluate the durability of the bond of different resin cement systems to normal dentin (ND) and caries-affected dentin (CAD) with and without simulated intrapulpal pressure (IPP). METHODS AND MATERIALS: Molars with midcoronal caries were used. Occlusal enamel was cut to expose both dentin substrates (ND and CAD). Dentin substrates were differentiated using visual, tactile, caries-detecting dye, and dye-permeability methods. Prepared crown segments were equally divided according to the tested resin cement systems: etch-and-rinse resin cement, self-etch resin cement containing methacryloyloxydecyl dihydrogen phosphate (MDP), and self-adhesive resin cement. In addition to the dentin substrates and the resin cement types, the effect of application/storage conditions (with or without simulated IPP and with or without thermocycling) were tested. A microtensile bond strength test was done using a universal testing machine. Failure modes were determined using a scanning electron microscope. RESULTS: Etch-and-rinse resin cement strength values were significantly affected by the difference in the dentin substrates as well as the different application/storage conditions. Self-etch adhesive containing MDP bonded equally to ND and CAD and remained stable under all tested conditions. Self-adhesive resin cement revealed a similar bond to ND and CAD; however, its values were the lowest, especially when IPP and thermocycling were combined. Mixed failure was the predominant failure mode. CONCLUSIONS: Etch-and-rinse resin cement was sensitive to dentin substrate and application/storage conditions. Resin cement with self-etch adhesive containing MDP revealed more reliable bonding to ND/CAD even when IPP and thermocycling were combined. The bonding of the self-adhesive resin cement could not compete with other resin cements.

In vitro longevity of bonding properties of universal adhesives to dentin.

PURPOSE: To evaluate the immediate and 6-month resin-dentin bond strength (µTBS) and nanoleakage (NL) of universal adhesives that contain or do not contain methacryloyloxydecyl dihydrogen phosphate (MDP) and are used in the etch-and-rinse and self-etch strategies. METHODS AND MATERIALS: Forty caries-free extracted third molars were divided into eight groups for µTBS (n=5). The groups were bonded with the Clearfil SE Bond (CSE) and Adper Single Bond 2 (SB) as controls; Peak Universal, self-etch (PkSe) and etch-and rinse (PkEr); Scotchbond Universal Adhesive, self-etch (ScSe) and etch-and-rinse (ScEr); and All Bond Universal, self-etch (AlSe) and etch-and-rinse (AlEr). After composite restorations, specimens were longitudinally sectioned to obtain resin-dentin bonded sticks (0.8 mm(2)). The µTBS of the specimens was tested immediately (IM) or after 6 months of water storage (6M) at 0.5 mm/min. Some sticks at each storage period were immersed in silver nitrate and photo developed, and the NL was evaluated with scanning electron microscopy. Data were analyzed with two-way repeated-measures analysis of variance and Tukey test (α=0.05). RESULTS: At the IM period, PkSe and PkEr showed µTBS similar to the control adhesives (p>0.05) but increased NL pattern and lower µTBS after 6M (p<0.05). ScSe and ScEr showed intermediary µTBS values at the IM period but remained stable after 6 months (p>0.05). AlSe showed the lowest µTBS (p<0.05), but µTBS and NL remained stable after 6M (p>0.05). AlEr showed higher IM µTBS but showed higher degradation after 6M (p<0.05). CONCLUSIONS: Universal adhesives that contain MDP showed higher and more stable µTBS with reduced NL at the interfaces after 6 months of water storage.

Effects of different surface treatments on bond strength between resin cements and zirconia ceramics.

This study compares the bond strength of resin cement and yttrium-stabilized tetragonal zirconia polycrystalline (Y-TZP) ceramic with different surface conditioning methods. Two hundred presintered Y-TZP ceramic specimens were prepared, sintered (4 × 4 × 4 mm), and randomly assigned to four equal groups as control (C, no conditioning); airborne particle abraded (APA, air abrasion with 11 µm Al2O3); tribochemical silica coating/silane coupling system (TSC, Rocatec, air abrasion with 110 µm Al2O3, 30 µm silica-coated Al2O3 and silane); and laser (L, Er:YAG laser irradiation treated at a power setting of 200 mJ). After specimen preparation, composite resin cylinders were prepared and cemented with resin cements (Clearfil Esthetic, Panavia F 2.0, Rely X-U100, Super Bond C&B, and Multilink Automix) on the ceramic surfaces and kept in an incubator at 37°C for 60 days. All specimens were tested for shear bond strength with a universal testing machine, and fractured surfaces were evaluated by environmental scanning electron microscopy. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U-tests (α=0.05). The bond strengths for C and L groups were not significantly different according to adhesive resin cement. APA and TSC resulted in increased bond strength for Panavia F 2.0 and Rely X-U100 resin cements. Additionally, TSC presented higher bond strength with Multilink Automix. Adhesive fracture between the ceramic and resin cement was the most common failure. Complete cohesive fracture at the ceramic or composite cylinders was not observed. Regardless of the adhesive resin cement used, laser treatment did not improve resin bond strength.

One-year clinical evaluation of composite restorations in posterior teeth: effect of adhesive systems.

This clinical study assessed the performance of posterior composite resins applied with the Adper™ Single Bond Plus (SB) and Adper™ Scotchbond SE (SE) adhesive systems and Filtek™ Supreme Plus composite resin, using modified US Public Health Service criteria. A total of 97 restorations were placed in posterior teeth by two calibrated operators. Application of the materials followed manufacturers' instructions. The restorations were evaluated by two examiners at baseline and after one year. Statistical analyses were conducted using the proportion test at a significance level of 5% (p<0.05). All the restorations evaluated (ie, 100%) received an alpha rating for the criteria of marginal discoloration and marginal integrity at baseline. At one year, for marginal discoloration, 64.6% of SB and 61.2% of SE received an alpha rating. For marginal integrity, 72.9% of SB and 77.6% of SE received an alpha rating. The other restorations received bravo ratings for both criteria. None of the teeth that received the restorative systems presented caries lesions around the restorations. A total of eight teeth presented postoperative sensitivity one week after baseline, five with SB and three with SE; the symptom had disappeared one year later. One year later, composite resin restorations using either adhesive system showed satisfactory clinical performance.

Variability of physicochemical properties of an epoxy resin sealer taken from different parts of the same tube.

AIM: To analyse several physicochemical properties of AH Plus (Dentsply DeTrey, Konstanz, Germany), including setting time, flow, radiopacity and the degree of conversion (DC); and to correlate the results with the source of the material: from the beginning, middle or end of the tubes in which they were supplied. METHODOLOGY: Three experimental groups were established for each property investigated. Group 1 corresponded to material taken from the beginning of tubes A and B; Group 2 corresponded to material taken from the middle of each tube; and group 3 corresponded to that from the end of each tube. The setting time, flow and radiopacity were studied according to American National Standards Institute/American Dental Association (ANSI/ADA) Specification 57. DC was determined from infrared spectra, which were recorded at 1-h intervals for the first 6 h; then, at 2-h intervals for the next 14 h; then, at 24 and 30 h. Data were analysed statistically by analysis of variance (anova), Tukey-Kramer, Kruskal-Wallis and Dunn tests, with a significance level of 5%. RESULTS: Group 1 had a significantly longer setting time (2303 ± 1058 min) (P < 0.05). Group 3 had the lowest flowability (30.0 ± 0.7 mm) and the highest radiopacity (14.85 ± 1.8 mm Al) (P < 0.05). No differences were found for the DC test (P > 0.05). CONCLUSION: The results suggest that segregation occurs between the organic and inorganic components of AH Plus sealer, thereby changing the setting time, flow and radiopacity.

Deproteinized dentin: a favorable substrate to self-bonding resin cements?

The adhesive performance on deproteinized dentin of different self-adhesive resin cements was evaluated through microtensile bond strength (µTBS) analysis and scanning electron microscopy (SEM). Occlusal dentin of human molars were distributed into different groups, according to the categories: adhesive cementation with two-step bonding systems-control Groups (Adper Single Bond 2 + RelyX ARC/3M ESPE; One Step Plus + Duolink/Bisco; Excite + Variolink I/Ivoclar Vivadent) and self-adhesive cementation-experimental groups (Rely X Unicem/3M ESPE; Biscem/Bisco; MultiLink Sprint/Ivoclar Vivadent). Each group was subdivided according to the dentin approach to: α, maintenance of collagen fibers and ß, deproteinization. The mean values were obtained, and submitted to ANOVA and Tukey test. Statistical differences were obtained to the RelyX Unicem groups (α = 13.59 MPa; ß = 30.19 MPa). All the BIS Group specimens failed before the mechanical tests. Dentinal deproteinization provided an improved bond performance for the self-adhesive cement Rely X Unicem, and had no negative effect on the other cementing systems studied.

Comparison of resin push-out strength to root dentin of bovine- and human-teeth.

AIM: To compare the push-out strength of bovine- and human-root dentin and, thus, evaluate the suitability of bovine-root dentin to substitute human-root dentin for bond strength testing. MATERIALS AND METHODS: Ten single-rooted human-teeth and ten bovine incisors were prepared using a #3 bur of a fiber post system (12 mm long). The posts were duplicated with resin cement (Duolink). The root canals were treated with All Bond 2 adhesive system and the resin posts were cemented using Duolink. The specimens were cut perpendicular to their long axis, yielding disc-specimens with 1.5 mm thickness, which were submitted to a push-out test (1 mm/min). Ten bond strength values per group (n = 10) were used for statistical analysis (Student t test, alpha =.05). RESULTS: Statistically significant differences were found for the bond strength values between bovine- (4.1 +/- 1.3 MPa) and human-root dentin (8.6 +/- 5.7 MPa) (P =.0001). CONCLUSION: The push-out strengths of bovine- and human-root dentin were statistically different.

Evaluation of monomer leaching from a dual cured resin cement.

PURPOSE: An increasing number of inlay cavities is restored with tooth-colored materials, especially ceramics are cemented with resin cements. The comonomer TEGDMA and other monomers Bis-GMA and UDMA have been identified as the main compounds released from polymerized resin cements into aqueous media. The present investigation was conducted to clarify the leaching behavior of the monomers of dual polymerized resin cement. MATERIAL AND METHODS: Ten freshly extracted caries and restoration free molar teeth were used in this study. Standardized Class I preparations were prepared in all teeth. Lithium disilicate based (IPS Empress Esthetic) ceramic inlays were cemented with dual polymerized resin cement (Variolink II). After cementation, specimens were stored in 75% ethanol solution. High-performance liquid chromatography (HPLC) was used to analyze the amounts of three monomers in the solution (after 10 min, 1 h, 24 h, 3, 7, 14, and 21 days). Two-way ANOVA and Tukey HSD tests were used to evaluate the results (p < 0.05). RESULTS: There were statistically significant differences among the amounts of the monomers (p < 0.01) and also among time periods (p < 0.01). While the TEGDMA resulted in significantly higher amount than Bis-GMA and UDMA, there were no statistically significant differences between amounts of Bis-GMA, UDMA (p = 0.06). The cumulative amount of monomers was the highest after 21 days (p < 0.01). CONCLUSION: In the case of resin cement, leaching of TEGDMA was the highest and the cumulative amount of leaching monomers from resin cement was influenced by the time.

The influence of endplate-to-endplate cement augmentation on vertebral strength and stiffness in vertebroplasty.

STUDY DESIGN: Controlled in vitro trial. OBJECTIVE: To study vertebral strength in relation to cement augmentation technique after vertebroplasty and to assess the influence of the biomechanical compression model on postoperative results. SUMMARY OF BACKGROUND DATA: In the treatment of osteoporotic vertebral fractures, the role of vertebroplasty has been well established. Biomechanical compression models thus far used, compressing vertebrae by only 25% of their initial height, did not show a correlation between cement augmentation volumes and postoperative compression strength. In these studies, even very small volumes of cement seem effective. However, these models may not realistically simulate clinically relevant osteoporotic wedge fractures. We hypothesize that, in clinically relevant osteoporotic wedge fractures, postoperative vertebral body strength is strongly dependent on endplate-to-endplate cement augmentation. METHODS: Twenty-five intact osteoporotic cadaver vertebrae were obtained (10 lumbar, 15 thoracic). In 21 vertebrae, anterior wedge fractures (AO type A1.2) were created by controlled external force, with preset height reduction by 35%. After height reconstruction, 9 vertebrae were augmented endplate-to-endplate and 12 vertebrae were partially augmented with polymethylmethacrylate (PMMA). Another 4 vertebrae were compressed by only 25%. Posttreatment strength and stiffness of the vertebrae were determined by a compression test identical to the pretreatment compression protocol. RESULTS: In the 35% compression group, posttreatment strength was significantly decreased in vertebrae that were partially augmented with cement compared with the endplate-to-endplate augmented group (767 +/- 257 N vs. 1141 +/- 325 N, P < 0.01). Postoperative strength amounted 106% +/- 27% of preoperative strength values in the endplate-to-endplate augmented vertebrae, compared with 65% +/- 18% in the partially augmented vertebrae (P < 0.001). In the 25% compression group, results in height restored and augmented vertebrae were similar to the nontreated vertebrae. CONCLUSIONS: Endplate-to-endplate PMMA augmentation restores the biomechanical properties of vertebrae in clinically relevant anterior wedge fractures. Our preliminary data suggest that biomechanical models with only 25% compressive deformation unlikely form a good model to assess the mechanical effects of cement augmentation in osteoporotic fractures.

Tensile bond strength of glass fiber posts luted with different cements.

Proper selection of the luting agent is fundamental to avoid failure due to lack of retention in post-retained crowns. The objective of this study was to investigate the tensile bond strength and failure mode of glass fiber posts luted with different cements. Glass fiber posts were luted in 40 mandibular premolars, divided into 4 groups (n = 10): Group 1--resin-modified glass ionomer RelyX Luting; Group 2--resin-modified glass ionomer Fuji Plus; Group 3--resin cement RelyX ARC; Group 4--resin cement Enforce. Specimens were assessed by tensile strength testing and light microscopy analysis for observation of failure mode. The tensile bond strength values of each group were compared by ANOVA and Tukey test. The significance level was set at 5%. The failure modes were described as percentages. The following tensile strength values were obtained: Group 1--247.6 N; Group 2--256.7 N; Group 3--502.1 N; Group 4--477.3 N. There was no statistically significant difference between Groups 1 and 2 or between Groups 3 and 4, yet the resin cements presented significantly higher tensile bond strength values than those presented by the glass ionomer cements. Group 1 displayed 70% of cohesive failures, whereas Groups 2, 3 and 4 exhibited 70% to 80% of adhesive failures at the dentin-cement interface. We concluded that resin cements and glass ionomer cements are able to provide clinically sufficient retention of glass fiber posts, and that glass ionomer cements may be especially indicated when the application of adhesive techniques is difficult.