Possible hazardous effects of hydrofluoric acid and recommendations for treatment approach: a review.

Hydrofluoric acid (HF) is commonly used for conditioning the glass ceramics either prior to cementation or for intraoral repair in prosthetic and restorative dentistry. The present study offers a review of chemical properties of HF used, highlight the possible hazardous effects of this agent, and to recommend the treatment approach for potential risks. Available published information documented in PubMed, Medline, and Picarta literature databases was reviewed. Additional information was derived from scientific reports, medical and chemical textbooks, handbooks, product information, manufacturers' instructions, Internet web sites of the HF manufacturers. No report was found on the incidence of the hazardous effects of HF in dentistry. Reports from other fields presented incidences of acute and chronic symptoms in exposure to HF. While acute symptoms include skin or nail burns, chronic ones involve systemic toxicity, eye injuries, inhalation and ingestion-related symptoms that can be even fatal. HF can be harmful and particularly aggressive to soft tissues, but symptoms may not be apparent immediately after exposure. The hazardous effects are not based on the pH value, but on the toxicity of HF. Potential hazards of HF known from other applications than dentistry should be considered also in dental applications. Especially the clinicians, who often deal with adhesive cementation or repair of glass ceramics, should take necessary precautions for possible hazards of HF.

An alternative method of fabricating a custom tray for direct implant impressions.

Creating accurate impressions for implants is essential for fabricating passive-fitting prostheses. This report describes a modified technique for fabricating a custom impression tray when implants are positioned unfavorably. A simple and accurate method of making an implant impression tray and the benefits of this technique are highlighted in this technical report.

Multidisciplinary approach to a nonsyndromic oligodontia patient using advanced surgical techniques.

Treatment of a woman suffering from oligodontia and multiple diastemata with insufficient alveolar ridges in both the maxilla and mandible is described in this clinical report. The total number of missing teeth was 11 (excluding the wisdom teeth). The treatment strategy consisted of an interdisciplinary team approach of orthodontic, surgical, and prosthodontic phases. Sinus floor augmentation, alveolar ridge augmentation via vertical alveolar distraction, and lateral augmentation with ramus graft procedures were performed after fixed orthodontic treatment and prior to dental implant placement. Oral rehabilitation of the patient was completed with the placement of fixed prostheses in the maxillary and mandibular posterior edentulous areas. Early dental intervention improved the patient's appearance and minimized the onset of emotional and psychosocial problems.

Effects of soldering and laser welding on bond strength of ceramic to metal.

STATEMENT OF PROBLEM: Welding or soldering of metal frameworks negatively affects the overall bond strength between the veneering ceramic and metal. PURPOSE: The purpose of this study was to evaluate the effect of soldering and laser-welding procedures on the bond strength between ceramic and metal. MATERIAL AND METHODS: Thirty Ni-based metal specimens (Wiron 99) (8 × 4 × 4 mm) were fabricated and divided into 3 groups; soldered (S), laser welded (L), and control (untreated cast alloy) (n=10). In S and L specimens, a notch (1 × 1.5 mm) was prepared longitudinally on the surface of each specimen and filled with compatible alloy (Wiron soldering rods and Wiroweld NC, respectively). Vickers hardness measurements were made after polishing the surfaces with a metallographic polishing kit. A veneering ceramic (VITA VMK 95) was vibrated, condensed in a mold, and fired on the metal frameworks. The specimens were sectioned in 2 axes to obtain nontrimmed bar specimens with a bonding area of approximately 1 mm². Forty bars per block were obtained. Each bar was subjected to microtensile bond strength (µTBS) testing with a crosshead speed of 1 mm/min. The µTBS data (MPa) were recorded, and SEM was used for failure analysis of the tested bars. The measurements were statistically analyzed using a 1-way ANOVA and Tamhane tests (α=.05). RESULTS: The mean differences in µTBS of veneering ceramic to soldered (10.4 ±2.4 MPa) and laser-welded (11.7 ±1.3 MPa) metal surfaces were not significantly different and were significantly lower than that of the cast alloy (25.4 ±3.6 MPa) (P<.05). The mean Vickers hardness of cast alloy was significantly higher (236 ±17 HV) than soldered (114 ±9 HV) and laser-welded groups (129 ±11 HV) (P<.05). CONCLUSIONS: Soldering and laser welding significantly decreased the µTBS of a veneering ceramic to a base metal alloy.

Bond strength comparison of amalgam repair protocols using resin composite in situations with and without dentin exposure.

The replacement of defective amalgam restorations leads to loss of tooth material and weakens the tooth, creating an increased risk of cusp fracture. The repair of such defects is a minimal intervention technique. The current study compared the repair bond strengths of a resin composite to amalgam and an amalgam-dentin complex after various surface conditioning methods. The specimens (N = 50) consisted of sound human canines with cylindrical preparations (diameter: 2.3 mm, depth: 3 mm) with amalgam-dentin complex (N = 30, n = 10/per group) and two groups with amalgam only (N = 20, n = 10/per group). The teeth were embedded in auto-polymerized polymethylmethacrylate (PMMA). The preparations were filled with non-Gamma 2 amalgam. The enamel was removed to expose dentin. The specimens with the amalgam-dentin complex were randomly assigned to one of the following conditioning methods: Group 1: Silicacoating amalgam, etching dentin, silane application on amalgam, primer/bonding on dentin, opaquer on amalgam, resin composite on both; Group 2: Etching dentin, silicacoating amalgam, silane application on amalgam, primer/bonding on dentin, opaquer on amalgam, resin composite on both and Group 3: Etching dentin, primer/bonding on dentin, opaquer, resin composite. The specimens with only amalgam were assigned to one of the following conditioning methods: Group 4: Silicacoating, silane application, opaquer, resin composite and Group 5: Opaquer, resin composite. For the two control groups, where no dentin was involved (Groups 4 and 5), bonding was achieved only on amalgam and Group 5 had no conditioning. The specimens were kept in water at 37 degrees C for five weeks before bond strength (MPa +/- SD) testing (Universal Testing Machine). After debonding, the failure types were analyzed. The results were significantly affected by the surface conditioning method (ANOVA). Only dentin conditioning (Group 3) showed the highest bond strength (39.9 +/- 14). The unconditioned control group (Group 5) showed the least favorable results (1.4 +/- 0.5). Multiple comparisons (Tukey-Kramer adjustment) showed that the mean values of Group 1 (34.1 +/- 11.4), 3 (39.9 +/- 14) and 4 (35.5 +/- 4) were not significantly different (p > 0.05), but between Groups 2 (22.8 +/- 6.6) and 3 (39.9 +/- 14), significant differences were observed (p = 0.0027). For reliable repair of amalgam restorations, including dentin fractures, the amalgam surface should first be silica coated, then the dentin/enamel should be etched, washed and rinsed thoroughly. Finally, the amalgam should be silanized and primer/bonding applied onto the dentin.

A preliminary report on short-term clinical outcomes of three-unit resin-bonded fixed prostheses using two adhesive cements and surface conditioning combinations.

PURPOSE: The aim of this study was to evaluate the survival rate of three-unit surface-retained, resin-bonded, metal-ceramic fixed dental prostheses (RBFDP) using two adhesive cements and two surface conditioning methods. MATERIALS AND METHODS: Between 2005 and 2009, a total of 58 patients (34 women, 24 men; mean age: 42.1 years) received 58 three-unit RBFDPs made of a nonprecious alloy (Wirocast Co-Cr). Restorations were cemented employing the following combinations: (1) alumina air abrasion-silane + Panavia F 2.0 (group A1), (2) tribochemical silica coating (CoJet)-silane + Panavia F 2.0 (group A2), (3) alumina air abrasion-silane + Super-Bond C and B (group B1), and (4) CoJet-silane + Super-Bond C and B (group B2). Teeth were conditioned using the adhesives of the cements accordingly. Adaptation, debonding, fracture, and crack and caries formation were considered for clinical evaluation. Data were collected at baseline, 6 months, and annually thereafter. Forty-eight RBFDPs were available for follow-up (mean: 20.3 months, minimum: 6 months, maximum: 42 months). RESULTS: The effect of cement type on the survival rate of RBFDPs was not significant (P > .05). The survival rate was also not significantly affected by the location (maxilla: 93.2%, mandible: 92.9%; P = .928). All experienced failures were observed within the first year after cementation. In total, four complete debondings were encountered (two in group A1, one in group A2, and one in group B1 at months 1, 3, 7, and 3, respectively). Group B2 did not result in any failures during the observation period. The failures were adhesive debondings between the metal surface and the cement. CONCLUSION: Early findings did not show significant differences between the cement and conditioning type combinations, with group B2 presenting no failures.

Immediate provisional restoration fabrication for immediate implant loading using a modified technique: a clinical report.

This article describes the immediate fabrication and placement of a provisional restoration, using a modified method for impressionmaking. An impression was made before surgery and provisional acrylic temporary restorations with composite resin frameworks were prepared on the solid-screw implant abutments. This article demonstrates this simple method and discusses the benefits of immediate provisionalization after surgery.

Influence of fluoride- or triclosan-based desensitizing agents on adhesion of resin cements to dentin.

Effect of desensitizers on the bond strength of resin cements to dentin was evaluated. Intact premolars (N = 90) were embedded in polymethyl methacrylate; dentin surfaces were exposed, and they were randomly divided into two main groups of cements (Duolink (D), Variolink II (V); n = 45 per group) and then into three desensitizer subgroups (n = 15 per subgroup). Teeth in controls (C) were treated according to cements' adhesion protocols; the other two groups received either fluoride- [Aqua-Prep F (F)] or triclosan-based [Seal&Protect (T)] desensitizers. Ceramic disks (Empress 2) were adhered; specimens were thermocycled (×5,000 cycles, 5-55 ± 1°C, dwell time 30 s) and subjected to shear bond strength test (MPa ± SD) in a universal testing machine (crosshead speed 1 mm/min). Failure types were classified using scanning electron microscope. For V, application of both desensitizers (29.6 ± 7.8 and 22.8 ± 2.8 for F and T, respectively) did not present significantly different results than that of the VC (21.2 ± 2.3; p > 0.05, one-way ANOVA). In D, F (20.6 ± 2.4) showed significantly higher results (p < 0.05) than those in T (16.1 ± 3.9) and DC group (15.2 ± 2.3). V showed significantly higher results than D (p < 0.05, Bonferroni). F and T did not negatively affect the bond strength results with D and V. Adhesive failures were more frequent with both T (84%) and F (66%) in D; cohesive failures in the cement (88%) were more commonly observed with F in V. Both F and T desensitizers can be safely used prior to final cementation but F in combination with V seems to be more reliable, considering both the bond strength and the failure types.

Preliminary evaluation of titanium tetrafluoride as an alternative ceramic etchant to hydrofluoric acid.

PURPOSE: The etching of dental ceramics with a glassy matrix by means of hydrofluoric acid (HF) is highly effective and after the application of a silane coupling agent, a strong link between the adhesive and the ceramic is achieved. The purpose of this study was to investigate whether aqueous titanium tetrafluoride (TiF4) solution could be used as an alternative ceramic etchant or not. MATERIALS AND METHODS: Seventy lithia-based all-ceramic specimens (IPS Empress 2, Ivoclar Vivadent) (diameter: 4 mm, height: 4 mm) were prepared and ultrasonically cleaned for 15 min in ethanol and deionized water, then divided into 1 control and 4 experimental groups (n = 14/group). The control group was acid etched with 4.9% HF for 20 s as described by the manufacturer. The experimental groups were treated with 2.5% TiF4 solution for 60 s, 2.5% TiF4 solution for 120 s and 5% TiF4 solution for 60 s, as well as 5% TiF4 solution for 120 s. Seven of the ceramic specimens in each group were luted to the other seven by a dual-curing cement (Variolink II, Ivoclar Vivadent,) with silane application (Monobond-S). After storage of luted specimens in deionized water at 37 degrees C for 24 h, the specimens were embedded in plastic holders with cyanoacrylate, and the shear-bond strength (SBS) tests were performed with a Shimadzu universal testing machine at a crosshead speed of 0.5 mm/min. A one-way ANOVA and Bonferroni correction, followed by the Tukey test, were applied for statistical analysis. Scanning electron microscopic examination was performed to evaluate the pattern of debonding. RESULTS: Significantly higher SBS values (p 0.05). CONCLUSION: Aqueous TiF4 solution exhibited similar shear bond strength values in comparison to commonly used HF and can be considered as an alternative ceramic etchant within the limitations of this preliminary report.

Influence of cervical finish line type on the marginal adaptation of zirconia ceramic crowns.

The current study evaluated the effect of different cervical finish line designs on the marginal adaptation of a zirconia ceramic. Four different marginal finish lines (c: chamfer, mc: mini-chamfer, fe: feather-edge and s: rounded shoulder) were prepared on phantom incisors. Die models for each preparation group (N = 28, n = 7 per finish line design group) were made of epoxy resin. Y-TZP (ICE Zirkon) frameworks were manufactured by a copy-milling system (Zirconzahn) using prefabricated blanks and tried on the master models for initial adaptation of the framework; they were then sintered, followed by veneering (Zirconzahn). The finished crowns were cemented with a polycarboxylate cement (Poly F) under 300 g load and ultrasonically cleaned. The specimens were sliced and the marginal gap was measured, considering absolute marginal opening (AMO) and marginal opening (MO) for each coping under a stereomicroscope with image processing software (Lucia). The measurements were statistically analyzed using the Kruskal Wallis, Mann Whitney and Wilcoxon Signed Ranks tests at a significance level of alpha = 0.01. Means of AMO measurement (microm) for the feather-edge finish line (87 +/- 10) was significantly lower than that of the chamfer (144 +/- 14), shoulder (114 +/- 16) and mini-chamfer finish line types (114 +/- 11) (p < 0.01). Means of MO measurements was the lowest for feather-edge finish line (68 +/- 9) (p < 0.01) and then, in ascending order, shoulder (95 +/- 9), mini-chamfer (97 +/- 12) and chamfer (128 +/- 10). The cervical finish line type had an influence on the marginal adaptation of the tested zirconia ceramic. Although the feather-edge finish line resulted in lower AMO and MO values, with its proven mechanical disadvantage, it cannot be recommended in clinical applications of zirconia crowns. This type of finish line has acted solely as a control group to test the null hypothesis in the current study. For better marginal adaptation, both shoulder and mini-chamfer finish line types could be suggested for zirconia crowns.

The effect of various preparation designs on the survival of porcelain laminate veneers.

PURPOSE: The aim of this clinical study was to observe the service duration of porcelain laminate veneers (PLVs) and to estimate the influence of the categorical covariates such as location, tooth vitality, preparation depth, incisal, gingival and proximal finishing lines, and peripheral tissue type on the survival rates of event-free and overall service duration. MATERIALS AND METHODS: A total of forty patients (26 women, 14 men; age range: 16 to 50) who had received 200 PLVs were evaluated in this study. Median follow-up time was 67.25 weeks with a range of 12 to 72 weeks. Fifteen of the restored teeth were nonvital, while the remaining 185 were vital. Categorical covariates related to the restoration design (localization, vitality, preparation depth, incisal, proximal, and gingival finishings, and surrounding tissue type) were recorded in order to estimate their influence on the survival rates. Survival rates of the event-free and overall service duration were calculated with the Kaplan-Meier analysis and Mantel log rank test. RESULTS: Twelve failures were observed. The most frequent failure type (11 units) was debonding of the restoration from the abutment tooth. Nine of them were rebonded and the remaining 2 were remade with a different preparation design. The last failure was observed as a coronal fracture at the cervical level. The overall survival rates were 99.5%, 99%, 97.5%, 94.9%, 94.4% and 93.8% at weeks 8, 9, 11, 15, 16, and 34, respectively, with a mean estimate of 68.45 weeks. CONCLUSION: PLVs exhibited good clinical results with their conservative specifications and high survival rates. The preparation and design specifications affect the service duration of PLVs.

Evaluation of bond strength of various margin ceramics to a zirconia ceramic.

OBJECTIVE: This study evaluated the bond strengths of four different margin ceramics based on fluoroapatite and feldspath to a zirconia ceramic. METHODS: Zirconia cores (Zirconzahn) (N=28, n=7/margin ceramic group) were fabricated according to the manufacturers' instructions (diameter: 4mm; thickness: 2mm) and ultrasonically cleaned. Four different margin ceramics (thickness: 5mm) (Cerabien Zr, Noritake; Ceramco PFZ, Ceramco; e.max, Ivoclar Vivadent and Triceram, Dentaurum) were vibrated and condensed in a stainless steel mould and fired onto their zirconia cores. After trying the specimens in the mould for minor adjustments, they were again ultrasonically cleaned and embedded in PMMA. The specimens were stored in distilled water at 37 degrees C for 1 week and shear bond strength (MPa+/-S.D.) tests were performed in a universal testing machine (crosshead speed: 0.5mm/min). Failure modes were recorded under SEM. RESULTS: Significant effect of margin ceramic types were found on the bond strength values (P<0.05). The mean bond strength values of Ceramco margin ceramic to zirconia was significantly lower (25.4+/-4.5 MPa) (P<0.05) than those of Cerabien (31.6+/-6.4 MPa), e.max (35.9+/-8.4 MPa), and Triceram margin ceramic (38.8+/-7.1 MPa) systems. CONCLUSIONS: Margin ceramics, compatible with zirconia framework material tested in the present study, exhibited high bond strength values. Variations in thermal expansion coefficients might influence their bond strength values.

Seven-year clinical follow-up study of Probond ceramic crowns.

OBJECTIVE: The Probond metal-ceramic system was proposed as an alternative to conventional metal-ceramic restorations. This study examined the 7-year survival and clinical performance of Probond metal-ceramic crowns. METHOD AND MATERIALS: A total of 200 patients were included in the study. All subjects required single-unit fixed prosthodontics in various areas of the mouth. The patients without any active periodontal or pulpal diseases, having adequate tooth structure and good oral hygiene, were included in the study, while patients with parafunctional habits were excluded. Overall clinical performance over 7 years was determined by using modified USPHS criteria and evaluated with Kaplan-Meier survival analysis. RESULTS: Seven failures were recorded among the 260 crowns placed. In the 4th year, 2 Probond crowns had minimal incisal fractures, and 1 restoration had a cervical fracture in the 2nd year. After 7 years, 2 Probond crowns were replaced with new Probond crowns as a result of fracture or trauma. Two restorations lost their occlusal contact integrity due to marginal ridge fractures. The formation of cracks and fractures as well as caries were significant (P <.05) at the 4- and 7-year recalls. Overall survival rates for marginal integrity, color stability, caries and crack formations, and occlusal integrity were 90.7%, 98.1%, 98.1%, 95.4%, and 99%, respectively, at 7 years. CONCLUSION: The durability of Probond ceramic crown restorations proved to be successful after 7 years.

Evaluation of metal bond strength to dentin and enamel using different adhesives and surface treatments.

Because adherence of base metal alloys is important for the long-term clinical success of adhesive fixed partial dentures, it has been necessary to improve adhesion to metal substrate by using different surface treatments. This study used different surface conditioning methods and two different luting resins to evaluate the shear bond strength of base metal alloys to dentin and enamel. Sixty noncarious freshly extracted human teeth were mounted in a plastic holder filled with autopolymerized acrylic resin. After the roots were removed and 30 flat enamel and 30 flat dentin surfaces were exposed, the specimens were divided randomly into two main luting cement groups. Sixty nickel chromium (NiCr) metal specimens were fabricated and subjected to three different surface conditioning procedures: sandblasting with 50 microm aluminum oxide, tribochemical silica coating, and a combination of the two. Scanning electron mircoscopy (SEM) evaluations revealed mainly cohesive failures. Self-cure adhesive resulted in higher bond strengths to dental substrates. Higher bond strengths were achieved through a combination of sandblasting and tribochemical silica coating; however, further clinical research is required. A surface treatment that combines sandblasting with tribochemical silica coating can achieve a more effective bond for adhesive restorations with metal substrates.

Treatment of localized anterior tooth wear with a glass-fiber-reinforced composite resin: a clinical report.

Developments in adhesive dentistry have provided the dental profession with new restorative materials and technology to restore esthetics and function to the worn anterior dentition. This clinical report describes treatment of localized anterior tooth wear with fiber-reinforced composite resin restorations as an alternative treatment method.

Comparison of two bond strength testing methodologies for bilayered all-ceramics.

OBJECTIVES: This study compared the shear bond strength (SBS) and microtensile (MTBS) testing methodologies for core and veneering ceramics in four types of all-ceramic systems. METHODS: Four different ceramic veneer/core combinations, three of which were feldspathic and the other a fluor-apatite to their respectively corresponding cores, namely leucite-reinforced ceramic ((IPS)Empress, Ivoclar), low leucite-reinforced ceramic (Finesse, Ceramco), glass-infiltrated alumina (In-Ceram Alumina, Vita) and lithium disilicate ((IPS)Empress 2, Ivoclar) were used for SBS and MTBS tests. Ceramic cores (N=40, n=10/group for SBS test method, N=5 blocks/group for MTBS test method) were fabricated according to the manufacturers' instructions (for SBS: thickness, 3mm; diameter, 5mm and for MTBS: 10 mm x 10 mm x 2 mm) and ultrasonically cleaned. The veneering ceramics (thickness: 2mm) were vibrated and condensed in stainless steel moulds and fired onto the core ceramic materials. After trying the specimens in the mould for minor adjustments, they were again ultrasonically cleaned and embedded in PMMA. The specimens were stored in distilled water at 37 degrees C for 1 week and bond strength tests were performed in universal testing machines (cross-head speed: 1mm/min). The bond strengths (MPa+/-S.D.) and modes of failures were recorded. RESULTS: Significant difference between the two test methods and all-ceramic types were observed (P<0.05) (2-way ANOVA, Tukey's test and Bonferroni). The mean SBS values for veneering ceramic to lithium disilicate was significantly higher (41+/-8 MPa) than those to low leucite (28+/-4 MPa), glass-infiltrated (26+/-4 MPa) and leucite-reinforced (23+/-3 MPa) ceramics, while the mean MTBS for low leucite ceramic was significantly higher (15+/-2 MPa) than those of leucite (12+/-2 MPa), glass-infiltrated (9+/-1 MPa) and lithium disilicate ceramic (9+/-1 MPa) (ANOVA, P<0.05). SIGNIFICANCE: Both the testing methodology and the differences in chemical compositions of the core and veneering ceramics influenced the bond strength between the core and veneering ceramic in bilayered all-ceramic systems.

Determination of elemental composition of substance lost following wear of all-ceramic materials.

PURPOSE: The aim of this study was to test the possible elemental release of four different all-ceramic materials in a wear machine to predict results about their long-term behavior in the oral environment. MATERIALS AND METHODS: Four different all-ceramic materials with different chemical compositions were selected for the wear testing. A total of 20 cylindric samples, five for each ceramic group, were prepared according to the manufacturers' instructions. These were subjected to two-body wear testing in an artificial saliva medium under a covered unit with a computer-operated wear machine. The artificial saliva solutions for each material were analyzed for the determination of amounts of sodium, potassium, calcium, magnesium, and lithium elements released from the glass-ceramic materials. The differences between and within groups were statistically analyzed with a one-way ANOVA, followed by Duncan tests. RESULTS: The statistical analyses revealed no significant differences among Na, K, Ca, or Mg levels (P > .05) released from the leucite-reinforced groups, while there was a significant (P < .05) increase in Li release from the lithium disilicate group. CONCLUSION: Considerable element release to the artifical saliva medium was demonstrated in short-term wear testing. The lithia-based ceramic was more prone to Li release when compared with other elements and materials.

Multidisciplinary approach to restoring anterior maxillary partial edentulous area using an IPS Empress 2 fixed partial denture: a clinical report.

Esthetics is a major concern during restoration of anterior partial edentulous areas. All-ceramic fixed partial dentures may provide better esthetics and biocompatibility in the restoration of anterior teeth. This clinic report describes a multidisciplinary approach and treatment procedures with an IPS Empress 2 fixed partial denture to restore missing anterior teeth.