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.

Effect of ultrasound on preheated resin composites used as ceramic luting agents.

This study investigated the effect of ultrasound application when luting ceramic using two preheated composites that show distinct responses to preheating at 69°C: Filtek Z100 and Z350XT. RelyX Veneer was the control. Feldspar disks were luted using the resin-based luting agents (RBLAs), and ultrasound was tested. Biaxial flexure strength (σbf) was calculated at z-axial positions of the luted disks (z=0; z=-t2). Microtensile bond strength (µTBS) to ceramic was tested (n=30). Data were analyzed at α=0.05. At z=0, the σbf was higher for Z350 when ultrasound was not used. When ultrasound was applied, the σbf was similar between Z350 and Z100. At z=-t2, differences across the RBLAs were observed: Z350 was superior than Z100 and control without ultrasound. Ultrasound increased σbf for Z100 at both axial positions. The preheated composites yielded higher µTBS than the control. Ultrasonication increased the mechanical performance of ceramic luted with Z100 without influencing the film thickness.

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.

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.

Randomized Controlled Trials in Implant Dentistry: Assessment of the Last 20 Years of Contribution and Research Network Analysis.

The aim of this study was to evaluate the characteristics of randomized controlled trials (RCTs) regarding implant-supported single tooth or fixed partial dentures. We performed searches (PubMed/MEDLINE and Web of Science) to identify all RCTs published from 1996 to 2016 and assessed publication details, study characteristics, international collaboration networks, and characteristics related to the implant-supported treatment. Two reviewers independently screened the titles/abstracts and selected full texts. A total of 122 RCTs were included, and most of the authors were from Europe (72%). Most trials did not report a trial registering number (89.9%) or sample size calculation (58.2%). The use of the CONSORT Statement increased over the past 9 years. Trials were mostly conducted at universities (54.9%), and only 13.1% compared 2 or more implant brands. Loading protocol was the most prevalent main comparison among the included studies, and most of the RCTs did not clearly report whether they excluded patients with known risk factors. The studies reviewed here presented different methodological and publication characteristics, and many did not show aspects aligned with current research practices.

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.

Ceramic strengthening by tuning the elastic moduli of resin-based luting agents.

OBJECTIVE: Resin-based luting agents (RBLAs) with tuned elastic moduli (E) were prepared and their influence on the strengthening, reliability, and mode of failure of luted feldspar ceramic was investigated. METHODS: RBLAs with low E (2.6GPa), intermediate E (6.6GPa), and high E (13.3GPa) were prepared and used to coat acid-etched ceramic disks. Positive (untreated ceramic) and negative (acid-etched ceramic) control groups were tested. The response variables (n=30) were biaxial flexural strength (σbf, MPa), characteristic strength (σ0, MPa), and Weibull modulus at the ceramic surface (z=0) and luting agent surface (z=-t2). A 3D finite element analysis simulated the biaxial flexural test. Fractographic analysis and morphology of the bonded interfaces were analyzed using scanning electron microscopy. RESULTS: The RBLAs improved σbf and σ0 at z=0, particularly those with intermediate and high E, whereas the mechanical reliability was only affected in the negative control. At z=-t2, differences between all RBLAs were observed but the structural reliability was independent of the RBLA tested. Increasing E of the RBLA was associated with increased stress concentration at the RBLA and reduced stresses reaching the ceramic. Failures originated on the ceramic surface at the ceramic-cement interface. In the high E group, failure sometimes originated from the RBLA free surface. All RBLAs completely filled the ceramic irregularities. SIGNIFICANCE: Increased E of the RBLA reduced the variability of strength, the stress reaching the ceramic structure, and sometimes altered the origin of failure. The use of high E RBLAs seems beneficial for luting feldspar ceramics.

Influence of silane and solvated bonding agents on the bond strength to glass-fibre posts.

The combined use of silane and solvated bonding agents on the bond strength to glass-fibre posts was investigated. A model Bis-GMA/HEMA adhesive was formulated with no solvent, 30% of ethanol or 80% of acetone. The surfaces of rectangular-shaped posts were silanated or not and one of the agents was applied, except for the control group. Cylinders of resin cement (RelyX ARC, 3M ESPE, Saint Paul, MN, USA) were built-up on the surfaces (n = 20) and submitted to shear testing. All groups showed higher bond strengths when the surfaces were silanated. When no silanization was carried out, the use of bonding agents, either solvated or non-solvated, increased the bond strengths. All groups treated with both silane and bonding agent showed higher bond strengths than the group that was only silanated. Control and ethanol-based adhesives were similar, whereas the acetone-based agent yielded higher bond strengths. Adhesive failures were predominant. Combination of silane and adhesive enhanced the bond to fibre posts.

Effects of horizontal misfit and bar framework material on the stress distribution of an overdenture-retaining bar system: a 3D finite element analysis.

PURPOSE: To evaluate the influence of horizontal misfit change and bar framework material on the distribution of static stresses in an overdenture-retaining bar system using finite element (FE) analysis. MATERIALS AND METHODS: A 3D FE model was created including two titanium implants and a bar framework placed in the anterior part of a severely resorbed jaw. The model set was exported to mechanical simulation software, where horizontal displacement (10, 50, 100, and 200 µm) was applied simulating the settling of the framework, which suffered shrinkage during laboratory procedures. Four bar materials (gold alloy, silver-palladium alloy, commercially pure titanium, and cobalt-chromium alloy) were also simulated in the analysis using 50 µm as the horizontal misfit. Data were qualitatively evaluated using von Mises stress, given by the software. RESULTS: The misfit amplification presented a great increase in the stress levels in the inferior region of the bar, screw-retaining neck, cervical and medium third of the implant, and cortical bone tissue surrounding the implant. The higher stiffness of the bar presented a considerable increase in the stress levels in the bar framework only. CONCLUSION: The levels of static stresses seem to be closely linked with horizontal misfit, such that its amplification caused increased levels of stress in the structures of the overdenture-retaining bar system. On the other hand, the stiffness of the bar framework presented a lower effect on the static stress levels.

Evaluation of stress distribution in overdenture-retaining bar with different levels of vertical misfit.

PURPOSE: To evaluate the effects of different levels of vertical misfit between implant and bar framework on distribution of static stresses in an overdenture-retaining bar system using finite element analysis. MATERIAL AND METHODS: A 3D finite element model (11,718 elements and 21,625 nodes) was created and included two titanium implants and a bar framework placed in the medial region of the anterior part of a severely reabsorbed-jaw. All materials were presumed to be linear elastic, homogenous, and isotropic. Mechanical simulation software (NEiNastran 9.0) was used, where displacements were applied on the end of the bar framework to simulate the closure of the vertical misfits (5, 25, 50, 100, 200, and 300 µm) after tightening of the screws. Data were qualitatively evaluated using Von Mises stress given by the software. RESULTS: The models showed stress concentration in cortical bone, corresponding to the cervical part of the implant, and in cancellous bone, corresponding to the apical part of the implant; however, in these regions few changes were observed in stress to the misfits studied. While in the bar framework, retaining-screw neck, and implant platform, a considerable stress increase proportional to the misfit amplification was observed. CONCLUSIONS: The different levels of vertical misfit did not considerably influence the static stress levels in the peri-implant bone tissue; however, the mechanical components of the overdenture-retaining bar system are more sensitive to lack of passive fit.

Influence of material of overdenture-retaining bar with vertical misfit on three-dimensional stress distribution.

PURPOSE: This study evaluated the effects of different bar materials on stress distribution in an overdenture-retaining bar system with a vertical misfit between implant and bar framework. MATERIALS AND METHODS: A three-dimentional finite element model was created including two titanium implants and a bar framework placed in the anterior part of a severely reabsorbed jaw. The model set was exported to mechanical simulation software, where displacement was applied to simulate the screw torque limited by 100-microm vertical misfit. Four bar materials (gold alloy, silver-palladium alloy, commercially pure titanium, cobalt-chromium alloy) were simulated in the analysis. Data were qualitatively evaluated using Von Mises stress given by the software. RESULTS: The models showed stress concentration in cortical bone corresponding to the cervical part of the implant, and in cancellous bone corresponding to the apical part of the implant; however, in these regions few changes were observed in the levels of stress on the different bar materials analyzed. In the bar framework, screw, and implant, considerable increase in stress was observed when the elastic modulus of the bar material was increased. CONCLUSIONS: The different materials of the overdenture-retaining bar did not present considerable influence on the stress levels in the periimplant bone tissue, while the mechanical components of the system were more sensitive to the material stiffness.

Bonding to wet or dry deproteinized dentin: micro tensile bond strength and confocal laser micromorphology analysis

Aim: To investigate the influence of deproteinization and moisture condition (wet vs. dry) on the bond strength and micromorphology of resin-dentin bonding interfaces. Methods: Dentin surfaces were etched with 37% phosphoric acid for 15 s and rinsed with water. Four groups (n = 10) were tested: WET: dentin was left visibly moist; DRY: dentin was dried with compressed air; WET-D: dentin was deproteinized for 60 s using 10% NaOCl solution and left moist; DRY-D: dentin was deproteinized and dried. Prime&Bond 2.1 adhesive was applied and the teeth were restored with composite resin. Microtensile test was carried out after 24 h, and failure modes classified under magnification. Data were subjected to two-way ANOVAand Tukey’s test (P < 0.05). The bonding micromorphology was analyzed by confocal laser scanning microscopy. Results: The group DRY showed significantly lower bond strength (P < 0.05) than the other groups, which were similar to each other (P > 0.05). Adhesive failures were predominant. Analysis of micromorphology showed formation of a collagen-resin hybrid layer only for the non-deproteinizedgroups. Adhesive penetration into the dentinal tubules was deeper for the DRY-D compared to the WETD group. Conclusion: The bond strength was not dependent on the moisture condition and a more homogeneous hybridization was obtained when dentin was deproteinized.