L.F. Valandro

Adhesive Quality of Self-adhesive and Conventional Adhesive Resin Cement to Y-TZP Ceramic Before and After Aging Conditions

PURPOSE This study evaluated the adhesive quality of simplified self-adhesive and conventional resin cements to Y-TZP in dry and aged conditions. METHODS Y-TZP ceramic blocks (N = 192) (5 x 5 x 2 mm) were embedded in acrylic resin and randomly divided into two groups, based on surface conditioning: 96% isopropanol or chairside tribochemical silica coating and silanization. Conditioned ceramics were divided into four groups to receive the resin cements (Panavia F 2.0, Variolink II, RelyX U100 and Maxcem). After 24 hours, half of the specimens (n = 12) from each group were submitted to shear bond strength testing (0.5 mm/minute). The remaining specimens were tested after 90 days of water storage at 37 degrees C and thermocycling (12,000x, 5 degrees C-55 degrees C). Failure types were then assessed. The data were analyzed using three-way ANOVA and the Tukeys test (alpha = 0.05). RESULTS Significant effects of ceramic conditioning, cement type and storage conditions were observed (p < 0.0001). The groups cleaned using alcohol only showed low bond strength values in dry conditions and the bond strength was reduced dramatically after aging. Groups conditioned using silica coating and silanization showed higher bond strengths both in dry and aged conditions. A high number of specimens failed prematurely prior to testing when they were cleaned using 96% isopropanol. CONCLUSION Overall, silica coating and silanization showed higher, stable bond strengths with and without aging. The durability of resin-ceramic adhesion varied, depending on the adhesive cement type.

An In Vitro Comparison of Different Cementation Strategies on the Pull-out Strength of a Glass Fiber Post

PURPOSE To evaluate the effect of different strategies for post cementation on the pullout bond strength of a double-tapered glass fiber post cemented into a root canal. MATERIALS AND METHODS The root canals of 70 single-rooted bovine teeth (16 mm-length) were prepared to 9 mm using the preparation drill of a double-tapered glass fiber post system (White Post DC, FGM). Each specimen was embedded in a plastic cylinder using acrylic resin up to 3 mm of the most coronal portion of the specimen and allocated into one of seven groups (n=10) based on strategies for cementation: Gr1-ScotchBond Multi Purpose plus (SBMP) + Relyx ARC resin cement; Gr2-Single Bond + Relyx ARC; Gr3-ED Primer + Panavia F resin cement; Gr4-SBMP + AllCem resin cement; Gr5-Relyx ARC; Gr6-Relyx Unicem resin cement; Gr7-Relyx Luting 2 glass ionomer cement. After cementation, the specimens were stored for seven days (in a humid environment at 37 degrees C) and submitted to pullout bond strength testing (the inferior part of each specimen was fixed and the fiber post was pulled out). The data (Kgf) were submitted to statistical analysis (one-way ANOVA and post-hoc Tukey tests, alpha=.05). The tested specimens were analyzed under the microscope and SEM for fracture analysis. RESULTS The strategy for post cementation affected the pullout retentive strength (Kgf) (p<0.0001) significantly. Gr6 (37.7 +/- 8a), Gr1 (37.4 +/- 5.7a) and Gr4 (31.6 +/- 6.6ab) presented the highest pullout bond strengths. Gr2 (12.2 +/- 5.6c), Gr3 (6.5 +/- 5.2c) and Gr7 (5.1 +/- 2.8c) presented the lowest pullout bond strengths. Gr5 (24.2 +/- 7.4b) was similar to Gr4 and inferior to Gr6 and Gr1. CONCLUSION The use of a three-step etch-&-rinse adhesive system appears to be effective. The application of other adhesive systems (single-bottle etch-&-rinse and self-etch adhesive systems) did not present high pullout strength values. The simplified self-adhesive resin cement (without adhesive application) presented good retentive performance. Further studies should be conducted.

Low-temperature degradation of Y-TZP ceramics: A systematic review and meta-analysis

The aim of this study was to systematically review the literature to assess if low-temperature degradation (LTD) simulation in autoclave promotes deleterious impact on the mechanical properties and superficial characteristics of Y-TZP ceramics compared to the non-aged protocol. The MEDLINE via PubMed electronic database was searched with included peer-reviewed publications in English language and with no publication year limit. From 413 potentially eligible studies, 49 were selected for full-text analysis, 19 were included in the systematic review with 12 considered in the meta-analysis. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias. Statistical analysis was performed using RevMan 5.1, with random effects model, at a significance level of p<0.05. Descriptive analysis of monoclinic phase content data showed that aging in autoclave promotes an increase in m-phase content (ranging from 0% up to 13.4% before and 2.13% up to 81.4% after aging) with intensity associated to the material susceptibility and to the aging parameters (time, pressure and temperature). Risk of bias analysis showed that only 1 study presented high risk, while the majority showed medium risk. Five meta-analyzes (factor: aging×control) were performed considering global and subgroups analyzes (pressure, time, temperature and m-phase % content) for flexural strength data. In the global analysis a significant difference (p<0.05) was observed between conditions, favoring non-aging group. Subgroup analysis revealed statistical difference (p<0.05) favoring non-aging, for aging time >20h. However, for shorter aging times (≤20h), there was no difference between groups. Pressure subgroup analysis presented a statistical difference (p<0.05) only when a pressure ≥2bar was employed, favoring non-aging group. Temperature subgroup analysis showed a statistical difference (p<0.05) only when temperature=134°C was used, favoring the non-aging group. M-phase % content analysis presented statistical difference (p<0.05) when more than 50% of m-phase content was observed, favoring non-aging group. High heterogeneity was found in some comparisons. Aging in autoclave promoted low-temperature degradation, impacting deleteriously on mechanical properties of Y-TZP ceramics. However, the effect of LTD depends on some methodological parameters indicating that aging time higher than 20h; pressure ≥2bar and temperature of 134°C are ideal parameters to promote LTD effects, and that those effect are only observed when more than 50% m-phase content is observed.

Effect of grinding with diamond-disc and -bur on the mechanical behavior of a Y-TZP ceramic

This study compared the effects of grinding on the surface micromorphology, phase transformation (t→m), biaxial flexural strength and structural reliability (Weibull analysis) of a Y-TZP (Lava) ceramic using diamond-discs and -burs. 170 discs (15×1.2mm) were produced and divided into 5 groups: without treatment (Ctrl, as-sintered), and ground with 4 different systems: extra-fine (25µm, Xfine) and coarse diamond-bur (181µm, Coarse), 600-grit (25µm, D600) and 120-grit diamond-disc (160µm, D120). Grinding with burs was performed using a contra-angle handpiece (T2-Revo R170, Sirona), while for discs (Allied) a Polishing Machine (Ecomet, Buehler) was employed, both under water-cooling. Micromorphological analysis showed distinct patterns generated by grinding with discs and burs, independent of grit size. There was no statistical difference for characteristic strength values (MPa) between smaller grit sizes (D600 - 1050.08 and Xfine - 1171.33), although they presented higher values compared to Ctrl (917.58). For bigger grit sizes, a significant difference was observed (Coarse - 1136.32>D120 - 727.47). Weibull Modules were statistically similar between the tested groups. Within the limits of this study, from a micromorphological point-of-view, the treatments performed did not generate similar effects, so from a methodological point-of-view, diamond-discs should not be employed to simulate clinical abrasion performed with diamond-burs on Y-TZP ceramics.

Effect of Acid Neutralization and Mechanical Cycling on the Microtensile Bond Strength of Glass-ceramic Inlays

OBJECTIVES To evaluate the hypothesis that a process of hydrofluoric acid precipitate neutralization and fatigue load cycling performed on human premolars restored with ceramic inlays had an influence on microtensile bond strength results (MTBS). METHODS MOD inlay preparations were performed in 40 premolars (with their roots embedded in acrylic resin). Forty ceramic restorations were prepared using glass-ceramic (IPS Empress). The inner surfaces of all the restorations were etched with 10% hydrofluoric acid for 60 seconds, rinsed with water and dried. The specimens were divided into two groups

Preliminary results of the survival and fracture load of roots restored with intracanal posts: weakened vs nonweakened roots.

PURPOSE To evaluate the fracture load and survival rate of weakened and non-weakened roots restored with different intracanal posts. METHODS Eighty teeth (16 mm) were prepared to a length of 10 mm with a custom drill. Fifty roots were weakened with a tapered diamond drill, and 30 roots were not. The specimens were embedded with acrylic resin up to 3 mm from the coronal aspect, and the periodontal ligament was simulated. The 50 weakened roots were restored with (n=10) CPC-gold (cast post and core made of gold alloy), CPC-Ni (cast post and core made of Ni-Cr alloy), FP (glass fiber posts), FP-W (glass fiber posts with a wider coronal diameter), and FP-CR (fiber posts relined with composite resin). The 30 nonweakened roots were restored with (n=10) CPC-gold, CPC-Ni, and FP. All of the posts were adhesively cemented. All of the specimens were mechanically cycled (37°C, 45°, 130 N, 2.2 Hz, and 1.5 million pulses) and evaluated after every 5 × 10(4) cycles to evaluate the presence of cracks as a primary outcome (event). The specimens that survived cycling were subjected to a fracture load test (load application on the palatal aspect at a 45° inclination). Failure mode was classified as favorable (above the simulated bone level) and catastrophic (below the simulated bone level). Survival rates were estimated using the Kaplan-Meier method. Fracture load data were analyzed using the Kruskal-Wallis test (α=0.05) for weakened roots, one-way analysis of variance, and Tukey test (p<0.05) for non-weakened roots, and Student t-test (p<0.05) compared nonweakened vs weakened roots for the same post system. RESULTS For the preliminary survival results, FP-W showed a higher survival rate when compared with CPC (gold/Ni). For the fracture load (N), the statistical analysis (p<0.0001) presented differences among the weakened groups: CPC-gold (541.4) = CPC-Ni (642.6) > FP (282.2) = FP-W (274.1) = FP-RC (216.6). No differences were observed for the groups that were nonweakened (majority of favorable failures): CPC-gold (459.3) = CPC-Ni (422.0) = FP (347.9). Weakened roots restored with CPC-gold promoted high values of load fracture and unfavorable failure rates. CONCLUSION Cast post and cores or fiber posts can be used for restoring nonweakened roots. However, for weakened roots, a fiber post with a wider cervical emerging diameter appears to be a better alternative when compared with cast post and cores.

The effect of grinding on the mechanical behavior of Y-TZP ceramics: A systematic review and meta-analyses

The aim of this study was to systematically review the literature to assess the effect of grinding on the mechanical properties, structural stability and superficial characteristics of Y-TZP ceramics. The MEDLINE via PubMed and Web of Science (ISI - Web of Knowledge) electronic databases were searched with included peer-reviewed publications in English language and with no publication year limit. From 342 potentially eligible studies, 73 were selected for full-text analysis, 30 were included in the systematic review with 20 considered in the meta-analysis. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias. Statistical analyses were performed using RevMan 5.1, with random effects model, at a significance level of 0.05. A descriptive analysis considering phase transformation, Y-TZP grain size, Vickers hardness, residual stress and aging of all included studies were executed. Four outcomes were considered in the meta-analyses (factor: grinding x as-sintered) in global and subgroups analyses (grinding tool, grit-size and cooling) for flexural strength and roughness (Ra) data. A significant difference (p<0.05) was observed in the global analysis for strength, favoring as-sintered; subgroup analyses revealed that different parameters lead to different effects on strength. In the global analysis for roughness, a significant difference (p<0.05) was observed between conditions, favoring grinding; subgroup analyses revealed that different parameters also lead to different effects on roughness. High heterogeneity was found in some comparisons. Generally grinding promotes decrease in strength and increase in roughness of Y-TZP ceramics. However, the use of a grinding tool that allows greater accuracy of the movement (i.e. contra angle hand-pieces coupled to slowspeed turbines), small grit size (<50μm) and the use of plenty coolant seem to be the main factors to decrease the defect introduction and allow the occurrence of the toughening transformation mechanism, decreasing the risk of deleterious impact on Y-TZP mechanical properties.

Effect of Hydrofluoric Acid Concentration on Resin Adhesion to a Feldspathic Ceramic.

PURPOSE To evaluate the effect of different concentrations of hydrofluoric acid (HF) on the contact angle and the resin bond strength durability to feldspathic ceramic. MATERIALS AND METHODS To evaluate the contact angles of distilled water on etched feldspathic ceramic, 25 specimens (12×10×2.4 mm) of VitaBlocks Mark II were used, divided into 5 groups (n=5): one unconditioned control (UC) group with no ceramic surface treatment, and 4 other groups that were etched for 60 s with different concentrations of HF: 1% (HF1), 3% (HF3), 5% (HF5) and 10% (HF10). The bond testing utilized 40 ceramic blocks (12×10×4 mm) that were fabricated and subjected to the same surface treatments as previously mentioned (excluding the control). The etched surfaces were silanized and resin cement was applied. After 24 h, the blocks were sectioned to produce bar specimens that were divided into two groups, non-aged (immediate testing) and aged (storage for 230 days+12,000 thermocycles at 5°C and 55°C), and subjected to microtensile testing (μTBS). Micromorphogical analysis of the treated surfaces was also performed (atomic force and scanning electron microscopy). One-way ANOVA and Tukeys tests were applied for data analysis. RESULTS UC had the highest contact angle (61.4°), whereas HF10 showed the lowest contact angle (17.5°). In non-aged conditions, different acids promoted statistically similar bond strengths (14.2 to 15.7 MPa) (p>0.05); in terms of bond durability, only the bond strength of the HF1 group presented a statistically significant decrease comparing before and after aging (14.5 to 10.2 MPa). CONCLUSION When etched with 3%, 5%, or 10% hydrofluoric acid, the ceramic tested showed stable resin adhesion after long-term aging.

Fatigue Resistance of Y-TZP/Porcelain Crowns is Not Influenced by the Conditioning of the Intaglio Surface

OBJECTIVES The objective of this study was to investigate the effects of treatments of the intaglio surface of Y-TZP frameworks and luting agents on the fatigue resistance of all-ceramic crowns. METHODS A research design was chosen that attempted to reduce the likelihood of Hertzian cracking and to increase the probability of fracture initiation at the intaglio surface of the framework. Ninety identical preparations were machined in a dentin-like epoxy composite. Each preparation was restored with a Y-TZP framework made by a CAD/CAM system and veneered using feldspathic ceramic. Prior to cementation the intaglio surface of the ceramic was treated using one of four treatments: 1) cleaning with isopropyl alcohol; 2) application of an overglaze; 3) sandblasting with 125 μm aluminum oxide powder; and 4) sandblasting with 30 μm silica powder (CJ). One of three luting cements were used: 1) zinc phosphate; 2) glass ionomer; and 3) adhesive resin cement (PN). All three cements were tested against frameworks that were alcohol cleaned. Only the PN cements were tested against frameworks that had been sandblasted or glazed. Altogether, six groups of 15 specimens each were tested. Fatigue resistance was evaluated using stepwise loads at 1.4 Hz until failure: 5000 cycles at maximum load of 200 N, followed by 10,000 cycles at maximum loads of 800, 1000, 1200, and 1400 N. The cement thickness and failure modes were analyzed using a stereomicroscope and scanning electron microscopy. The results were analyzed using the Kaplan-Meier and Mantel-Cox log rank tests (5%), a one-way analysis of variance, Tukey multiple comparison test, and Weibull nonparametric test. RESULTS The predominant failure mode was chipping of the veneer. The crowns cemented with the adhesive resin cement exhibited chipping failure at higher mean loads than did crowns cemented with cements that usually do not bond strongly with dentin. When the adhesive cement was used, glazing and sandblasting intaglio framework surface treatments exhibited lower mean loads at chipping than did crowns whose intaglio surface was only cleaned with alcohol. Weibull analysis indicated that all specimens had a high ratio of late-to-early failures. CONCLUSIONS The fatigue experiment produced a pattern of failures that is very similar to that observed in clinical trials of Y-TZP crowns that are veneered with feldspathic porcelain. Crowns cemented with an adhesive resin cement exhibited chipping at a significantly higher mean load than those cemented with luting cements that do not usually form strong bonds with dentin. When cemented with adhesive resin cement, glazing or sandblasting the intaglio surface of the framework significantly reduced the mean fatigue loads at which chipping of veneers occurred, as compared to crowns whose intaglio surface had only been cleaned with alcohol. For this cement glazing or sandblasting the intaglio surface of the crown is not recommended.

Inlays Made From a Hybrid Material: Adaptation and Bond Strengths

The aim of this study was to evaluate the internal fit, marginal adaptation, and bond strengths of inlays made of computer-aided design/computer-aided manufacturing feldspathic ceramic and polymer-infiltrated ceramic. Twenty molars were randomly selected and prepared to receive inlays that were milled from both materials. Before cementation, internal fit was achieved using the replica technique by molding the internal surface with addition silicone and measuring the cement thicknesses of the pulpal and axial walls. Marginal adaptation was measured on the occlusal and proximal margins of the replica. The inlays were then cemented using resin cement (Panavia F2.0) and subjected to two million thermomechanical cycles in water (200 N load and 3.8-Hz frequency). The restored teeth were then cut into beams, using a lathe, for microtensile testing. The contact angles, marginal integrity, and surface patterns after etching were also observed. Statistical analysis was performed using two-way repeated measures analysis of variance (p<0.05), the Tukey test for internal fit and marginal adaptation, and the Student t-test for bond strength. The failure types (adhesive or cohesive) were classified on each fractured beam. The results showed that the misfit of the pulpal walls (p=0.0002) and the marginal adaptation (p=0.0001) of the feldspathic ceramic were significantly higher when compared to those of the polymer-infiltrated ceramic, while the bond strength values of the former were higher when compared to those of the latter. The contact angle of the polymer-infiltrated ceramic was also higher. In the present study, the hybrid ceramic presented improved internal and marginal adaptation, but the bond strengths were higher for the feldspathic ceramic.