James Kit-Hon Tsoi

Aspects of bonding between resin luting cements and glass ceramic materials

OBJECTIVES The bonding interface of glass ceramics and resin luting cements plays an important role in the long-term durability of ceramic restorations. The purpose of this systematic review is to discuss the various factors involved with the bond between glass ceramics and resin luting cements. METHODS An electronic Pubmed, Medline and Embase search was conducted to obtain laboratory studies on resin-ceramic bonding published in English and Chinese between 1972 and 2012. RESULTS AND DISCUSSION Eighty-three articles were included in this review. Various factors that have a possible impact on the bond between glass ceramics and resin cements were discussed, including ceramic type, ceramic crystal structure, resin luting cements, light curing, surface treatments, and laboratory test methodology. CONCLUSIONS Resin-ceramic bonding has been improved substantially in the past few years. Hydrofluoric acid (HF) etching followed by silanizaiton has become the most widely accepted surface treatment for glass ceramics. However, further studies need to be undertaken to improve surface preparations without HF because of its toxicity. Laboratory test methods are also required to better simulate the actual oral environment for more clinically compatible testing.

A new modified laser pretreatment for porcelain zirconia bonding

OBJECTIVES The aim of this study was to compare the effects of three different surface treatments in enhancing porcelain zirconia bonding. METHODS Totally, 160 densely sintered zirconia specimens were prepared and randomly divided into four study groups: control (no treatment, Group C), sandblasting (Group S), sandblasting followed by regeneration firing (Group SH), and laser irradiation (pulse mode) on a CO₂ laser system (Group L). After surface treatment, porcelain powders were veneered on zirconia surface. Half of the specimens in each group were evaluated without aging (initial shear bond strength - initial SBS), and the other half was tested after being stored in water for one month (aging SBS). X-ray diffractometry (XRD) was used to observe any crystallographic transformation at zirconia surface. Results were statistically analyzed using analysis of variance (ANOVA) and Turkey test (=0.05). RESULTS The initial average SBS values of Group S, Group SH, and Group L were 31.3 ± 5.7 MPa, 29.2 ± 7.0 MPa and 32.1 ± 7.5 MPa, respectively. The differences among these three groups were not significant. The control group had significantly lower value, 24.8 ± 6.7 MPa, than those of Group S and Group L. Furthermore, there was no significant difference between initial and aging values in each group. XRD analysis showed that sandblasting caused tetragonal to monoclinic phase transformation. Regeneration firing reversed such a transformation. However, crystallographic transformation could not be detected in laser treated specimens. SIGNIFICANCE Both sandblasting and laser irradiation increased porcelain zirconia bond strength. The presented new modified laser pre-treatment might be an alternative way to sandblasting for improving zirconia/porcelain integration.

Comparison of mechanical properties of three machinable ceramics with an experimental fluorophlogopite glass ceramic

STATEMENT OF PROBLEM Fluorophlogopite glass ceramic (FGC) is a biocompatible, etchable, and millable ceramic with fluoride releasing property. However, its mechanical properties and reliability compared with other machinable ceramics remain undetermined. PURPOSE The purpose of this in vitro study was to compare the mechanical properties of 3 commercially available millable ceramic materials, IPS e.max CAD, Vitablocs Mark II, and Vita Enamic, with an experimental FGC. MATERIAL AND METHODS Each type of ceramic block was sectioned into beams (n=15) of standard dimensions of 2×2×15 mm. Before mechanical testing, specimens of the IPS e.max CAD group were further fired for final crystallization. Flexural strength was determined by the 3-point bend test with a universal loading machine at a cross head speed of 1 mm/min. Hardness was determined with a hardness tester with 5 Vickers hardness indentations (n=5) using a 1.96 N load and a dwell time of 15 seconds. Selected surfaces were examined by scanning electron microscopy and energy-dispersive x-ray spectroscopy. Data were analyzed by the 1-way ANOVA test and Weibull analysis (α=.05). Weibull parameters, including the Weibull modulus (m) as well as the characteristic strength at 63.2% (η) and 10.0% (B10), were obtained. RESULTS A significant difference in flexural strength (P<.001) was found among groups, with IPS e.max CAD (341.88 ±40.25 MPa)>Vita Enamic (145.95 ±12.65 MPa)>Vitablocs Mark II (106.67 ±18.50 MPa), and FGC (117.61 ±7.62 MPa). The Weibull modulus ranged from 6.93 to 18.34, with FGC showing the highest Weibull modulus among the 4 materials. The Weibull plot revealed that IPS e.max CAD>Vita Enamic>FGC>Vitablocs Mark II for the characteristic strength at both 63.2% (η) and 10.0% (B10). Significant difference in Vickers hardness among groups (P<.001) was found with IPS e.max CAD (731.63 ±30.64 H(V))>Vitablocs Mark II (594.74 ±25.22 H(V))>Vita Enamic (372.29 ±51.23 H(V))>FGC (153.74 ±23.62 H(V)). CONCLUSIONS The flexural strength and Vickers hardness of IPS e.max CAD were significantly higher than those of the 3 materials tested. The FGCs flexural strength was comparable with Vitablocs Mark II. The FGCs Weibull modulus was the highest, while its Vickers hardness was the lowest among the materials tested.

Evaluation of four surface coating treatments for resin to zirconia bonding.

OBJECTIVES To compare the effects of four surface coating methods on resin to zirconia shear bond strength. MATERIAL AND METHODS Eighty pre-sintered zirconia discs were prepared and randomly divided into five study groups according to the corresponding methods of surface treatments as follows: group C (control group, fully sintered without any surface treatment), group S (fully sintered and then sandblasted with silica coated alumina powder), group G (fully sintered and then coated with glazing porcelain followed by acid etching), group Si (pre-coated with silica slurry then fully sintered), and group Z (coated with zirconia particles and then fully sintered). The observation of surface morphology and elemental composition analysis were conducted by SEM and EDX. Self-adhesive resin cement stubs (diameter 3.6mm and height 3mm) were then bonded on the zirconia discs with a cylindrical shape. Both initial and artificial aged (including 30-day water storage, thermal cycling for 3000 and 6000 cycles) shear bond strengths were then evaluated. RESULTS All the tested coating methods showed significantly higher shear bond strengths than the control group, in both dry and aged conditions. Group S produced the strongest initial zirconia/resin bonding (19.7MPa) and the control group had the lowest value (8.8MPa). However, after thermal cycling, group Z exhibited the highest mean value. All the samples in the control group failed in the thermal cycling. Both different coating methods (p<0.001) and various aging treatments (p<0.001) produced significant influence on resin-zirconia shear bond strength. CONCLUSIONS A reliable and durable resin zirconia bonding is vital for the longevity of dental restorations. Silica coating might be a reliable way in enhancing adhesion between resin and zirconia.

Static and fatigue mechanical behavior of three dental CAD/CAM ceramics

PURPOSE The aim of this study was to measure the mechanical properties and fatigue behavior of three contemporary used dental ceramics, zirconia Cercon(®) (ZC), lithium disilicate e.max(®) CAD (LD), and polymer-infiltrated ceramic Enamic(®) (PIC). METHODS Flexural strength of each CAD/CAM ceramic was measured by three point bending (n=15) followed by Weibull analysis. Elastic modulus was calculated from the load-displacement curve. For cyclic fatigue loading, sinusoidal loading with a frequency of 8Hz with minimum load 3N were applied to these ceramics (n=24) using three point bending from 10(3) to 10(6) cycles. Fatigue limits of these ceramics were predicted with S-N fatigue diagram. Fracture toughness and Vickers hardness of the ceramics were measured respectively by single edge V-notch beam (SEVNB) and microindentation (Hv 0.2) methods. Chemical compositions of the materials׳ surfaces were analyzed by EDS, and microstructural analysis was conducted on the fracture surfaces by SEM. One-way ANOVA was performed and the level of significance was set at 0.05 to analyze the numerical results. RESULTS The mean flexural strength of ZC, LD, and PIC was respectively 886.9, 356.7, and 135.8MPa. However, the highest Weibull modulus belonged to PIC with 19.7 and the lowest was found in LD with 7.0. The fatigue limit of maximum load for one million cycles of ZC, LD, and PIC was estimated to be 500.1, 168.4, and 73.8GPa. The mean fracture toughness of ZC, LD, and PIC was found to be respectively 6.6, 2.8, and 1.4MPam(1/2), while the mean Vickers hardness was 1641.7, 676.7, and 261.7Hv. Fracture surfaces followed fatigue loading appeared to be smoother than that after monotonic loading. CONCLUSIONS Mechanical properties of ZC were substantially superior to the two other tested ceramics, but the scattering of data was the least in PIC. The fatigue limit was found to be approximately half of the mean flexural strength for all tested ceramics.

Effects of some chemical surface modifications on resin zirconia adhesion

OBJECTIVES To evaluate the effects of various chemical surface modifications on adhesion between zirconia and resin adhesive. MATERIAL AND METHODS Pre-sintered zirconia discs were sectioned from commercial cylindrical blocks and polished with abrasive papers under running tap water. All the discs were randomly divided into five study groups according to the methods of surface treatment, including: the control group (fully sintered, without any modification), group S (fully sintered and sandblasted with silica coated alumina particles), group HN (fully sintered and etched with a blend of mineral acid solution at 100 °C for 25 min), group HF (fully sintered and etched with 48% hydrofluoric acid solution at 100 °C for 25 min), and group Si (coated with silica particles and then fully sintered). The mean value of surface roughness was evaluated before further treatment. Resin stubs (3.6mm in diameter and 3mm in height) were adhered and light cured on each zirconia disc after the application of a silane coupling agent. In each group, all the samples were further divided into three subgroups with each n=12, one for the measurement of initial adhesion strength (shear bond) value and the other two were tested after thermal cycling for 10,000 and 20,000 cycles, respectively. The results were analyzed with two-way ANOVA and Turkey HSD (p<0.05). XRD technique was utilized in the examination of zirconia surface crystallinity. The morphological appearance of zirconia surface after surface treatment was observed with SEM. RESULTS The control group showed the lowest initial shear bond strength (SBS) value (16.8 ± 2.4 MPa) and did not survive the aging treatments. All the investigated surface treatments improved resin zirconia bond strength significantly, the group S displaying the highest initial value of 25.1 ± 2.7 MPa. However, the highest resistance to the aging effects of thermal cycling was found in group Si. It was further shown in the XRD examination that only the grit-blasting caused the crystalline transformation from tetragonal phase to monoclinic phase (T → M). On the other hand, such a phase transformation could not be detected in all the other four groups. SIGNIFICANCE Resin zirconia adhesion could be effectively improved by both HF etching and silica coating on zirconia surface, without leading to a T → M crystalline phase transformation.

Candida albicans aspects of novel silane system-coated titanium and zirconia implant surfaces.

OBJECTIVES The aim of the present study was to evaluate the effect of novel silane system coatings on zirconia and titanium implant surfaces and the attachment of the fungal pathogen Candida albicans. MATERIALS AND METHODS Titanium and zirconia specimens were silica-coated and silanized either with a commercial silane primer (RelyX Ceramic Primer™, 3M ESPE) or a novel silane system primer. The novel silane system primer was a blend of 1.0 vol% 3-acryloxypropyltrimethoxysilane and 0.3 vol% bis-1,2-(triethoxysilyl)ethane diluted in acidified ethanol-water solvent. The surface roughness (Ra ), the surface free energy and the chemical composition of substrate surfaces after treatments were evaluated. C. albcans biofilms were developed on silica-coated + silanized surfaces during 48 h of incubation time. Colony forming units (CFU) and real-time PCR (RT-PCR) quantified the cells on the material surfaces. Statistical analyses were carried out by 1-way ANOVA, Tukey post hoc and Games Howell post hoc test at 5% significance level (p). RESULTS On zirconia and titanium surfaces, the Ra and the chemical composition of the specimens were equal (P < 0.05). The surface free energy was decreased on titanium specimens and increased on zirconia specimen after silanization. CFU of C. albicans was significantly lower on zirconia coated with RelyX Ceramic Primer™, (P < 0.001) and on titanium coated with both silanes (P = 0.002). RT-PCR revealed no differences between the mean quantities of C. albicans (P ≥ 0.067). CONCLUSION Silica-coating and silanization had modified the titanium and zirconia surfaces significantly. Both the control and experimental silane primers might inhibit the biofilm formation of C. albicans.

Effect of flavonoids on the mechanical properties of demineralised dentine

OBJECTIVES This study compared the effect of three flavonoids: proanthocyanidin, naringin and quercetin on the modulus of elasticity (MOE) and ultimate tensile strength (UTS) of demineralised dentine. METHODS Thirty teeth were sectioned into 0.5mm×1.7mm×7mm beams for MOE measurement. Another 30 non-carious molars were sectioned into 0.5mm×0.5mm thick dentine beams for UTS testing. Demineralised specimens were divided into three groups according to treatments: 6.5% proanthocyanidin, 6.5% quercetin and 6.5% naringin. Specimens were kept in their respective solutions and tested at baseline, 10min, 30min, 1h and 4h. The MOE of each specimen was determined using a three-point bending test at a crosshead speed of 0.5mm/min. For UTS evaluation, each specimen was tested in tension until failure using a crosshead speed of 1mm/min. Means and standard deviation were calculated. Two-way ANOVA and Tukey test were used to evaluate the effect of flavonoid treatment and treatment duration on MOE and UTS. RESULTS Both MOE and UTS were significantly affected by flavonoid treatment (p<0.001) and treatment duration (p<0.001). Interaction of the two factors was significant for MOE (p<0.001), but not for UTS (p>0.05). Flavonoid treatment improved the mechanical properties of demineralised dentine in the order: proanthocyanidin>quercetin>naringin. It took a longer time for the flavonoids to produce a significant change in UTS, when compared to MOE. CONCLUSION Proanthocyanidin was more effective than quercetin and naringin in improving biomechanical properties of dentine matrix, thereby enhancing preventive and reparative dental therapies. CLINICAL SIGNIFICANCE Despite its larger molecular size, proanthocyanidin was more effective than quercetin and naringin, in enhancing the biomechanical properties of demineralised dentine.

Silane adhesion mechanism in dental applications and surface treatments: A review

OBJECTIVE To give a current review of silane adhesion chemistry, applications of silane coupling agents and related surface pretreatment methods in contemporary dentistry. METHODS Silane coupling agents are adhesion promoters to chemically unify dissimilar materials used in dentistry. Silanes are very effective in adhesion promotion between resin composites and silica-based or silica-coated indirect restorative materials. It is generally accepted that for non-silica-based restorations, surface pretreatment is a mandatory preliminary step to increase the silica content and then, with help of silane, improve resin bonding. This review discusses the silane-based adhesion chemistry, silane applications in dentistry, surface pretreatment methods, and presents the recent development of silane coupling agents. RESULTS A silane coupling agent is considered a reliable, good adhesion promoter to silica-based (or silica-coated) indirect restorations. Surface pre-treatment steps, e.g., acid etching for porcelain and tribo-chemical silica-coating for metal alloys, is used before silanization to attain strong, durable bonding of the substrate to resin composite. In clinical practice, however, the main problem of resin bonding using silanes and other coupling agents is the weakening of the bond (degradation) in the wet oral environment over time. SIGNIFICANCE A silane coupling agent is a justified and popular adhesion promoter (adhesive primer) used in dentistry. The commercial available silane coupling agents can fulfil the requirements in clinical practice for durable bonding. Development of new silane coupling agents, their optimization, and surface treatment methods are in progress to address the long term resin bond durability and are highly important.

Effects of a zirconate coupling agent incorporated into an experimental resin composite on its compressive strength and bonding to zirconia

AIM To assess in vitro the compressive strength of an experimental zirconate coupling agented resin composite and its bonding to dental zirconia ceramics. METHODS Various ratios (1.5-4.0wt%) of a zirconate coupling agent, NZ-33(®), zirconium(IV)-2,2[(bis-2-propenolatomethyl)butanolato-tris-2-methyl-2-propenoato-O)] were incorporated in an experimental bis-GMA/MMA-based resin composite formulation with silica fillers. Compressive strength of the experimental resin composite and shear bond strength (SBS) of the resin composite to zirconia were evaluated by using a universal testing machine. Specimens were stored in dry condition, in water storage for 7 days and for 14 days, to a total of twenty test groups. The data were analyzed by one-way ANOVA and Tukey post hoc test (α=0.05). RESULTS SBS of resin-to-zirconia bonding and compressive strength both have significant increase at 1.5wt% and 3.0wt% NZ-33(®) (p<0.05). However, water storage for 7 days (p>0.05) and 14 days (p>0.05) significantly decreased SBS of the experimental resin-to-zirconia with no significant difference between groups (p>0.05). CONCLUSIONS An addition of a zirconate coupling agent used might strengthen the biomechanical properties of the experimental resin composite.