Gulfem Ergun

Factors affecting the mechanical behavior of Y-TZP

AIM The aim was to evaluate the influence of sandblasting with various propulsion pressures on the phase transformation, flexural strength and Weibull modulus of a yttria stabilized tetragonal zirconia polycrystalline ceramic (Y-TPZ). In addition, the susceptibility of cyclic loading and low-temperature degradation under two different conditions (chemical and thermal aging) was investigated. MATERIALS AND METHODS The specimens [105bar-shaped specimens (19.3×14.5×1.3mm(3))] were equally divided into seven groups (n=15) according to the test protocols. The specimens in control group received no surface treatment (Group A). Groups B1, B2 and B3 were airborne-particle abraded with 110μm Al2O3 particles at 200kPa, 400kPa and 600kPa (2bar, 4bar and 6bar) pressure, respectively. Group C was submitted to mechanical cyclic loading under 200N 20,000 times sinusoidal loading/unloading at a frequency of 10Hz between 10% and 100% load in distilled water at 37°C. Group D was submitted to thermal degradation in an autoclave at 134°C under additional 200kPa pressure for 5h. Group E was immersed in 4% acetic acid at 80±5°C for 168h as chemical degradation testing. Following each treatment protocols, the three-point flexure test was used to calculate the flexural strength. Additionally, X-ray diffraction analysis was used to estimate the relative amount of monoclinic phase. The reliability of strength was assessed through the Weibull distribution. Statistical analysis was conducted with one-way ANOVA and Tukey׳s pairwise multiple comparisons. The treated and fractured surfaces were observed with SEM. RESULTS Statistical analysis revealed that there were significant differences among the flexural strength results of all tested groups (F=4.510, p<0.05). Group B2 demonstrated the highest strength values, whereas Group E showed the lowest (625.86±123.57; 466.56±91.50, respectively). Weibull moduli of all tested groups were statistically significant and ranging from 4.3 to 8.3. A greater amount of monoclinic phase was determined in the specimens of D, E and B3 groups (25.43%, 20.89% and 19.71%, respectively). However, lower amount was observed in groups A, B1 and B2 (10.02%, 13.35% and 15.19%, respectively). CONCLUSIONS The present study suggested that flexural strength of zirconia was significantly decreased by chemical degradation. In addition, surface conditioning, cyclic fatigue and thermal, chemical degradation conditions significantly changed the structural reliability of the materials strength.

Comparison between regional micropush-out and microtensile bond strength of resin composite to dentin.

Objective. In this study we compared the micropush-out (µ-PO) and microtensile (µ-TBS) test methods for resin composites on different levels and surfaces of dentin. Material and Methods. Thirty-four sound human molars were divided into two groups in accordance with the dentin surface used (occlusal (O) or mesio-distal (M)), then subdivided into a further two groups in accordance with the test method (µ-PO (P) or µ-TBS (T)). In groups OP and OT, teeth were ground occlusally perpendicular to their axis, and in groups MP and MT, mesio-distally parallel to their axis to expose dentin. Dentin disks were prepared from different regions of the teeth either in an occluso-cervical (group OP) (n=5) or mesio-distal direction (group MP) (n=5) (S, superficial; M, middle; D, deep). One-hundred-and-twenty standardized occlusal cavities were prepared in these dentin disks using a conical-shaped diamond rotary cutting instrument. The adhesive (Adper Scotchbond Multi-Purpose Dental Adhesive) and a composite material (Filtek Z250 Universal Restorative) were applied and polymerized with a LED light curing unit (Elipar FreeLight 2). The disks (n=20/per group) were tested in a universal testing machine and pushed out with a cross-head speed of 1.0 mm/min. In groups OT (n=12) and MT (n=12), the teeth were ground to expose superficial, middle, and deep dentin. Build-ups of resin composite were constructed with the same materials. The specimens were serially sectioned and trimmed to hour-glass shapes, then tested with the µ-TBS tester at a rate of 1 mm/min. Failure modes were examined using a stereomicroscope and scanning electron microscope. Results. ANOVA revealed significant differences among the groups (p<0.001). With the push-out test, no premature failure occurred, the variability of the data distribution was acceptable, and regional differences in bond strength among dentin levels could be assessed. Conclusions. The µ-PO test method could be an alternative to the µ-TBS technique.

Micro-shear bond strength of different resin cements to ceramic/glass-polymer CAD-CAM block materials.

PURPOSE The aim of this study was to evaluate the effects of hydrofluoric acid treatment on bond strength of resin cements to three different types of ceramic/glass containing CAD-CAM block composite materials. METHODS CAD-CAM block materials of polymer infiltrated (Vita Enamic), resin nanoceramic (Lava Ultimate) and nanoceramic (Cerasmart) with a thickness of 1.5mm were randomly divided into two groups according to the surface treatment performed. In Group 1, specimens were wet-ground with silicon carbide abrasive papers up to no. 1000. In Group 2, 9.6% hydrofluoric acid gel was applied to ceramics. Three different resin cements (RelyX, Variolink Esthetic and G-CEM LinkAce) were applied to the tubes in 1.2-mm thick increments and light-cured for 40s using LED light curing unit. Half of the specimens (n=10) were submitted to thermal cycling (5000 cycles, 5-55°C). The strength measurements were accomplished with a universal testing machine (Lloyd Instruments) at a cross-head speed of 0.5mm/min until the failure occurs. Failure modes were examined using a stereomicroscope and scanning electron microscope. The data were analyzed with multivariate analysis of variance (MANOVA) and Tukeys post hoc tests (α=0.05). RESULTS There were significant differences between ceramics and resin cements (p<0.001). However, hydrofluoric acid gel treatment had no effect on bond strength values (p=0.073). In addition, thermal cycling significantly decreased bond strength values of resin cements to ceramics (p<0.001). CONCLUSIONS Use of appropriate resin cement systems with different ceramic/glass-polymer materials might promote the bonding capacity of these systems.PURPOSE The aim of this study was to evaluate the effects of hydrofluoric acid treatment on bond strength of resin cements to three different types of ceramic/glass containing CAD-CAM block composite materials. METHODS CAD-CAM block materials of polymer infiltrated (Vita Enamic), resin nanoceramic (Lava Ultimate) and nanoceramic (Cerasmart) with a thickness of 1.5mm were randomly divided into two groups according to the surface treatment performed. In Group 1, specimens were wet-ground with silicon carbide abrasive papers up to no. 1000. In Group 2, 9.6% hydrofluoric acid gel was applied to ceramics. Three different resin cements (RelyX, Variolink Esthetic and G-CEM LinkAce) were applied to the tubes in 1.2-mm thick increments and light-cured for 40s using LED light curing unit. Half of the specimens (n=10) were submitted to thermal cycling (5000 cycles, 5-55°C). The strength measurements were accomplished with a universal testing machine (Lloyd Instruments) at a cross-head speed of 0.5mm/min until the failure occurs. Failure modes were examined using a stereomicroscope and scanning electron microscope. The data were analyzed with multivariate analysis of variance (MANOVA) and Tukeys post hoc tests (α=0.05). RESULTS There were significant differences between ceramics and resin cements (p<0.001). However, hydrofluoric acid gel treatment had no effect on bond strength values (p=0.073). In addition, thermal cycling significantly decreased bond strength values of resin cements to ceramics (p<0.001). CONCLUSIONS Use of appropriate resin cement systems with different ceramic/glass-polymer materials might promote the bonding capacity of these systems.

Osseointegration of fiber-reinforced composite implants: Histological and ultrastructural observations

OBJECTIVES The aim of this study was to evaluate the bone tissue response to fiber-reinforced composite (FRC) in comparison with titanium (Ti) implants after 12 weeks of implantation in cancellous bone using histomorphometric and ultrastructural analysis. MATERIALS AND METHODS Thirty grit-blasted cylindrical FRC implants with BisGMA-TEGDMA polymer matrix were fabricated and divided into three groups: (1) 60s light-cured FRC (FRC-L group), (2) 24h polymerized FRC (FRC group), and (3) bioactive glass FRC (FRC-BAG group). Titanium implants were used as a control group. The surface analyses were performed with scanning electron microscopy and 3D SEM. The bone-implant contact (BIC) and bone area (BA) were determined using histomorphometry and SEM. Transmission electron microscopy (TEM) was performed on Focused Ion Beam prepared samples of the intact bone-implant interface. RESULTS The FRC, FRC-BAG and Ti implants were integrated into host bone. In contrast, FRC-L implants had a consistent fibrous capsule around the circumference of the entire implant separating the implant from direct bone contact. The highest values of BIC were obtained with FRC-BAG (58±11%) and Ti implants (54±13%), followed by FRC implants (48±10%), but no significant differences in BIC or BA were observed (p=0.07, p=0.06, respectively). TEM images showed a direct contact between nanocrystalline hydroxyapatite of bone and both FRC and FRC-BAG surfaces. CONCLUSION Fiber-reinforced composite implants are capable of establishing a close bone contact comparable with the osseointegration of titanium implants having similar surface roughness.

Effect of different light curing methods on mechanical and physical properties of resin-cements polymerized through ceramic discs

Objective The aim of this study was to compare the polimerization ability of three different light-curing units (quartz tungsten halogen, light-emitting diodes and plasma arc) and their exposure modes (high-intensity and soft-start) by determination of microhardness, water sorption and solubility, and diametral tensile strength of 5 dual-curing resin cements. Material and methods A total of 720 disc-shaped samples (1 mm height and 5 mm diameter) were prepared from different dual-curing resin cements (Duolink, Nexus, Bifix-QM, Panavia F and RelyX Unicem). Photoactivation was performed by using quartz tungsten halogen (high-power and soft-up modes), light-emitting diode (standard and exponential modes) and plasma arc (normal and ramp-curing modes) curing units through ceramic discs. Then the samples (n=8/per group) were stored dry in the dark at 37ºC for 24 h. The Vickers hardness test was performed on the resin cement layer with a microhardness tester (Shimadzu HMV). For sorption and solubility tests; the samples were stored in a desiccator at 37ºC and weighed to a constant mass. The samples were weighed both before and after being immersed in deionized water for different periods of time (24 h and 7 days) and being desiccated. The diametral tensile strength of the samples was tested in a universal testing machine at a crosshead speed of 0.5 mm/min. Data were analyzed statistically by nonparametric Kruskal Wallis and Mann-Whitney U tests at 5% significance level. Results Resin cement and light-curing unit had significant effects (p<0.05) on microhardness, diametral tensile strength, water solubility and sorption. However, no significant differences (p>0.05) were obtained with different modes of LCUs. Conclusion The study indicates that polymerization of resin cements with different light-curing units may result in various polymer structures, and consequently different mechanical and physical properties.

Effect of Surface Modification on the Bond Strength between Zirconia and Resin Cement

PURPOSE This study aimed to evaluate the micro push-out (μ-PO) bond strength between zirconia and resin cement after addition of zirconia particles to increase the surface roughness. MATERIALS AND METHODS Y-TZP zirconia specimens in three experimental groups were subjected to Y-TZP particle deposition via dipping into the milling residue suspension at different times prior to the sintering process. The dipping procedure was repeated twice for each specimen in group B, six times in group C, and ten times in group D. The specimens subjected to airborne-particle abrasion (110 μm Al2 O3, Rocatec Pre) acted as the control group (group A). All of the specimens were then bonded using adhesive resin cement (RelyX Ultimate). A μ-PO test was used to determine the bond strength values. One-way ANOVA at a 5% confidence level was performed for data analysis. Optical microscopy and scanning electron microscopy (SEM) were used to evaluate the failure modes and surface structure. RESULTS Y-TZP particle deposition did not have a significant effect on the bond strength of the resin cement to zirconia specimens when compared to the control (p = 0.141). Higher bond strength values were observed in groups C and D than in control. The surface layer presented blister-like porosities with openings of various diameters ranging between 2 and 4 μm. CONCLUSION Y-TZP particle deposition after dipping six and ten times did not improve the mean bond strength statistically but presented surface topography that may be favorable for increased micromechanical retention for adhesive resin cement. CLINICAL SIGNIFICANCE Y-TZP particle deposition may create a more retentive surface than airborne-particle abrasion for adhesive bonding between zirconia surface and resin cement.

Effect of reduced exposure times on the cytotoxicity of resin luting cements cured by high-power led.

Objective Applications of resin luting agents and high-power light-emitting diodes (LED) light-curing units (LCUs) have increased considerably over the last few years. However, it is not clear whether the effect of reduced exposure time on cytotoxicity of such products have adequate biocompatibility to meet clinical success. This study aimed at assessing the effect of reduced curing time of five resin luting cements (RLCs) polymerized by high-power LED curing unit on the viability of a cell of L-929 fibroblast cells. Material and Methods Disc-shaped samples were prepared in polytetrafluoroethylene moulds with cylindrical cavities. The samples were irradiated from the top through the ceramic discs and acetate strips using LED LCU for 20 s (50% of the manufacturers recommended exposure time) and 40 s (100% exposure time). After curing, the samples were transferred into a culture medium for 24 h. The eluates were obtained and pipetted onto L-929 fibroblast cultures (3x104 per well) and incubated for evaluating after 24 h. Measurements were performed by dimethylthiazol diphenyltetrazolium assay. Statistical significance was determined by two-way ANOVA and two independent samples were compared by t-test. Results Results showed that eluates of most of the materials polymerized for 20 s (except Rely X Unicem and Illusion) reduced to a higher extent cell viability compared to samples of the same materials polymerized for 40 s. Illusion exhibited the least cytotoxicity for 20 s exposure time compared to the control (culture without samples) followed by Rely X Unicem and Rely X ARC (90.81%, 88.90%, and 83.11%, respectively). For Rely X ARC, Duolink and Lute-It 40 s exposure time was better (t=-1.262 p=0,276; t=-9.399 p=0.001; and t=-20.418 p<0.001, respectively). Conclusion The results of this study suggest that reduction of curing time significantly enhances the cytotoxicity of the studied resin cement materials, therefore compromising their clinical performance.

Bonding of lithium-disilicate ceramic to enamel and dentin using orthotropic fiber-reinforced composite at the interface

Objective. To evaluate the effect of orthotropic fiber-reinforced composite (FRC) at the interface on bonding of lithium-disilicate ceramic to dentin and enamel using different adhesive systems. Material and Methods. Dentin and enamel surfaces were ground occlusally on human molar teeth. Ceramic blocks of IPS Empress 2 (Ivoclar-Vivadent) were fabricated. Following acid etching and silane treatment of the ceramics, the teeth were divided into two groups (dentin and enamel). Ceramic blocks were bonded to the tooth substance with or without a layer of FRC and dual-polymerizing composite cement (Duolink). Total-etching (etchant (Etch 37) with adhesive (One Step Plus)) and self-etching (self-priming etchant (Tyrian SPE) with adhesive (One Step Plus)) systems were used, with five test specimens in each group. The cement was polymerized with a LED curing unit (Elipar Freelight LED 2) with standard mode of 40 s. The specimens were thermocycled for 6000 cycles and tested with the microtensile tester at a rate of 5 mm/min. Fracture mode analyses were done by light microscope and with SEM. The data were analyzed using three-way analysis of variance (ANOVA). Results. ANOVA showed that enamel had statistically significant (p<0.001) higher bond strength values than dentin. Bond strength values were significantly higher (p=0.012) with the total-etching system than with the self-etching system. The existence of FRC also had a minor effect on bond strength values (p=0.013). Conclusions. The enamel and total-etching system provided more reliable bonding than dentin and the self-etching system. Use of an FRC layer at the interface did not improve bond strength values, but instead changed fracture pattern behavior.

Bond strength of self-adhesive resin cements to dentin after antibacterial and chelating solution treatment

OBJECTIVE The aim of this study was to evaluate the effect of tetracycline HCl, 1-hydroxyethylidene-1, 1-bisphosphonate (HEBP) and chlorhexidine digluconate (CHX) on micro push-out (µ-PO) bond strengths of two self-adhesive resin cements on dentin. MATERIALS AND METHODS Sixty discs of 1.25 mm thickness (middle dentin) were prepared from human molars perpendicular to the tooth axis. Two standardized occlusal cavities of 2.20 mm occlusal diameter and 1.25 mm cervical diameter were prepared in each disc. The cavities were divided into three groups in accordance with the surface treatment (50 mg/ml tetracycline HCl, 18% HEBP and 2% CHX solutions). Following the treatment of the discs for 5 min, cavities were filled with two different self-adhesive resin cements (Clearfil(™) SA Cement and RelyX(™) Unicem). After light polymerization of cements, µ-PO bond strength tests were performed. Failure modes were examined and dentin morphologic assessments were done. Statistical significance was determined by a multivariate analysis of variance (MANOVA) followed by Tukeys post-hoc test (p < 0.05). Additionally, a paired-samples T-test was used to compare the µ-PO bond strengths of self-adhesive resin cements (p < 0.05). RESULTS Paired-samples T-test revealed that there was no significant difference between tested self-adhesive resin cements (p = 0.612). No significant two-factor interaction was observed between Clearfil(™) SA Cement and chemical agents (p = 0.457). Similarly, tetracycline HCl and CHX did not have a significant effect on the bond strength of RelyX(™) Unicem (p > 0.05). However, HEBP significantly decreased the bond strength of RelyX(™) Unicem when compared to the control (p < 0.05). Conclusion. The tetracycline HCl and CHX solutions do not have beneficial effects on µ-PO bond strengths of self-adhesive resin cements. Additionally, the results of this study do not justify the use of self-adhesive resin cements, following HEBP treatment of dentin. CLINICAL SIGNIFICANCE The application of topical HEBP solution treatment to dentin could have adverse effects on the µ-PO bond strengths of RelyX(™) Unicem.

Light transmittance of zirconia as a function of thickness and microhardness of resin cements under different thicknesses of zirconia

Objective: The objective of this study was to compare microhardness of resin cements under different thicknesses of zirconia and the light transmittance of zirconia as a function of thickness. Study design: A total of 126 disc-shaped specimens (2 mm in height and 5 mm in diameter) were prepared from dual-cured resin cements (RelyX Unicem, Panavia F and Clearfil SA cement). Photoactivation was performed by using quartz tungsten halogen and light emitting diode light curing units under different thicknesses of zirconia. Then the specimens (n=7/per group) were stored in dry conditions in total dark at 37°C for 24 h. The Vicker’s hardness test was performed on the resin cement layer with a microhardness tester. Statistical significance was determined using multifactorial analysis of variance (ANOVA) (alpha=.05). Light transmittance of different thicknesses of zirconia (0.3, 0.5 and 0.8 mm) was measured using a hand-held radiometer (Demetron, Kerr). Data were analyzed using one-way ANOVA test (alpha=.05). Results: ANOVA revealed that resin cement and light curing unit had significant effects on microhardness (p < 0.001). Additionally, greater zirconia thickness resulted in lower transmittance. There was no correlation between the amount of light transmitted and microhardness of dual-cured resin cements (r = 0.073, p = 0.295). Conclusion: Although different zirconia thicknesses might result in insufficient light transmission, dual-cured resin cements under zirconia restorations could have adequate microhardness. Key words:Zirconia, microhardness, light transmittance, resin cement.