Laura E. Tam

Fracture Strength and Fatigue Resistance of All‐Ceramic Molar Crowns Manufactured with CAD/CAM Technology

PURPOSE All-ceramic crowns are subject to fracture during function, especially in the posterior area. The use of yttrium-stabilized zirconium-oxide ceramic as a substructure for all-ceramic crowns to improve fracture resistance is unproven. The aim of this study was to compare fracture strength and fatigue resistance of new zirconium-oxide and feldspathic all-ceramic crowns made with computer-aided design/computer-aided manufacturing (CAD/CAM). MATERIALS AND METHODS An ivorine molar was prepared to receive an all-ceramic crown. Using epoxy resin, 40 replication dies were made of the prepared tooth. Twenty feldspathic all-ceramic crowns (Vita Mark II) (VMII) and 20 zirconium-oxide crown copings (In-Ceram YZ) (YZ) were made using CAD/CAM technique (CEREC-3D). The YZ copings were sintered and veneered manually with a fine-particle ceramic (VM9). All crowns were cemented to their respective dies using resin cement (Panavia F 2.0). Ten crowns in each group were subjected to compressive fatigue loading in a universal testing machine (instron). The other ten crowns from each group were loaded to fracture at a crosshead speed of 1 mm/min. Data were statistically analyzed using independent t-test and Fishers exact test at alpha= 0.05. RESULTS There was a significant difference between the survival rates of the two materials during the fatigue test (p < 0.001). All VMII crowns survived without any crack formation, while all YZ crowns fractured (40%) or developed cracks (60%). All the YZ crown fractures occurred within the veneering layer during the fatigue test. There was no significant difference in mean fracture load between the two materials (p= 0.268). Mean fracture loads (standard deviation) in N were: 1459 (492) for YZ crowns and 1272 (109) for VMII crowns. CONCLUSIONS The performance of VMII crowns was superior to YZ crowns in the fatigue test. The premature fractures and cracks of the YZ crowns were attributed to weakness in the YZ veneer layer or in the core/veneer bond.

The use of MDP-based materials for bonding to zirconia

STATEMENT OF PROBLEM A strong and stable bond between the luting resin and overlying ceramic restoration is critical to longevity, but no technique has been established for how to provide such a bond when the core material is zirconia. PURPOSE The purpose of this study was to evaluate the effect of different materials containing 10-methacryloyloxydecyl dihydrogen phosphate (MDP) on the bond strength to yttria-tetragonal zirconia polycrystal (Y-TZP) ceramic. MATERIAL AND METHODS Forty Y-TZP slices (Lava) were cemented to substrates (8 groups; n=5 in each) with or without the previous application of an experimental primer (0.5% MDP) or an MDP-based adhesive (Clearfil S3 Bond Plus or Scotchbond Universal) with either an MDP (Clearfil SA) or a non-MDP (RelyX Ultimate) luting resin. Specimens were cut, stored in distilled water, and microtensile tested (5 beams per specimen) at 48 hours and again at 6 months after luting procedures. The data were analyzed by 4-way ANOVA (α=.05) and the Tukey test (α=.05). The mode of failure was classified with a stereomicroscope, and the treated surfaces were analyzed with energy-dispersive x-ray spectroscopy. RESULTS Both adhesive (P<.001) and time (P<.001) significantly affected bond strength. The interaction of any of the factors was not significant. The use of an MDP-containing adhesive and the shorter storage time were associated with higher bond strengths. At 48 hours, an overall incidence of 50.5% of Type 1 mode of failure (adhesive at ceramic/resin interface) occurred, as opposed to 68% after 6 months of water storage. Energy-dispersive x-ray spectroscopy results showed peaks of carbon and phosphorus when MDP-based materials were used. CONCLUSIONS The application of an MDP-based adhesive may improve bond strength to zirconia. However, microtensile bond strength results for all groups did not remain stable over 6 months.

Physical properties of calcium hydroxide and glass-ionomer base and lining materials.

Compressive, diametral tensile and flexural strengths, moduli of elasticity, pH, and acid solubility values were compared for six calcium hydroxide cements, seven glass-ionomer cements, and one calcium aluminate cement. Results indicated that the glass-ionomer materials were generally stronger than the calcium hydroxide liners. Prisma VLC Dycal showed the lowest value for modulus of elasticity and the least acid solubility. The glass-ionomer materials were initially acidic, reaching a final pH between 5.4 and 7.3, whereas the calcium hydroxide and calcium aluminate cements were strongly alkaline at all time intervals.

Effect of salivary esterase on the integrity and fracture toughness of the dentin-resin interface

Human Salivary Derived Esterases (HSDE) are part of the salivary group of enzymes which show strong degradative activity toward the breakdown of one of the most common monomers used in dental composites and adhesives, 2,2-[4(2-hydroxy 3-methacryloxypropoxy)-phenyl] propane (Bis-GMA), to form the degradation product 2,2-bis [4 (2,3-hydroxy-propoxy)phenyl] propane (Bis-HPPP). This study was aimed to evaluate the effects of HSDE on the biodegradation and fracture toughness of the adhesive resin-dentin interface. Adhesive resin (Scotchbond Multi Purposes), resin composite (Z250) and mini short-rod specimens, were either not incubated; or incubated in phosphate-buffered saline (PBS) or HSDE media for up to 180 days (37 degrees C, pH 7.0). The amount of Bis-HPPP was analyzed by high performance liquid chromatography and mini-SR specimens were tested for fracture toughness using universal testing machine following 30, 90, or 180-day incubation periods. Significantly higher amounts of Bis-HPPP were produced in HSDE than in PBS incubated specimens (p < 0.05). Non-incubated mini-SR specimens had the higher fracture-toughness values, while specimens incubated for 180-days in HSDE had the lowest fracture toughness (p < 0.05). This study suggests that biodegradation is an on-going clinically relevant process that progressively compromises the integrity of the critical resin restoration-adhesive interface, as well as the resin-composite component with time.

Fracture resistance of dentin-composite interfaces using different adhesive resin layers

OBJECTIVES The objective of this study was to study the effect of different adhesive layers on the interfacial fracture toughness (K(ICi)) of dentin-resin composite interfaces. METHODS Miniature short-rod fracture toughness specimens containing a chevron-shaped dentin-bonded interface along their midplane were used for testing. Each interface zone contained a thinned (one coat of unfilled adhesive resin, air-thinned), one-layer (one coat of unfilled adhesive resin, brush-thinned), two-layer (two coats of unfilled adhesive resin, brush-thinned), 10% filled or 45% filled adhesive resin layer. After storage in distilled water at 37 degrees C for 24h, the fracture toughness test specimens were loaded in tension at an extension rate of 0.5mm/min until fracture and the K(ICi) were determined. The results were analysed by ANOVA and Fishers LSD test (p<0.05). Scanning electron microscopy was used to examine representative fracture surfaces. RESULTS There were no significant differences in mean K(ICi) among the different unfilled adhesive resin layer groups. SEM examination of these specimens showed that fracture generally occurred between the resin-infiltrated layer and adhesive resin layer during interfacial fracture toughness testing. The mean K(ICi) for the 10% filled groups was not significantly different from the unfilled groups. The 45% filled group, however, demonstrated the highest K(ICi) values, the thickest adhesive resin layer under SEM examination, and a fracture path through the adhesive resin layer. CONCLUSIONS There were no significant differences in K(ICi) when the unfilled adhesive resin was used despite different application methods. The 45% filled adhesive resin improved the properties of the dentin-composite interface with respect to both interfacial fracture resistance and dentinal seal after fracture.

Effect of dentine depth on the fracture toughness of dentine-composite adhesive interfaces

OBJECTIVES The fracture toughness test was recently introduced as a clinically relevant method for assessing the fracture resistance of the dentine-composite interface. The objective of this study was to evaluate the effect of dentine depth on the interfacial fracture toughness test of several dentine-composite interfaces using some new proprietary dentine bonding agents. METHODS Miniature short rod fracture toughness specimens containing a chevron-shaped dentine-composite-bonded interface were prepared for each group (n = 12). Six different dentine bonding agents and two dentine depths were the variables assessed at the dentine-composite interfaces. After 24 h at 37 degrees C in water, the specimens were tested by loading at 0.5 mm/min in the Instron Universal Testing Machine. The interfacial KIC results were analysed by ANOVA, unpaired Students t-tests and Fishers LSD test (P < 0.05). RESULTS The interfacial KIC results in MN.m-3/2 (S.D.) on superficial and deep dentine, respectively, were: All-Bond 2, 0.80 (0.21), 0.44 (0.13); Bond-lt, 0.75 (0.20), 0.38 (0.19); Prime and Bond, 0.56 (0.11), 0.28 (0.10); Scotchbond Multi-Purpose, 0.45 (0.23), 0.26 (0.15); One-Step and OptiBond, insufficient results due to premature specimen failures. CONCLUSIONS The results from this study should contribute to the development of the fracture toughness test as a method for assessing the integrity of the dentine-composite interface. The interfacial fracture toughness test determined significant differences among the different dentine bonding agents and between the superficial and deep dentine substrates. The dentine bonding agents showed significantly reduced interfacial fracture toughness results when bonding to deep versus superficial dentine.

Shear bond strengths of resin luting cements to laboratory-made composite resin veneers

Retention problems have been reported with the clinical use of indirect microfilled resin veneers. This study used 24-hour shear tests to assess the bond strengths of such a resin veneer compared with other veneer types. The effect of different resin luting cements and resin veneer surface treatments were analyzed to elucidate factors by which retention could be increased. The six resin luting systems investigated showed a range of bond values. Debonding occurred primarily at the veneer/cement interface. G-Cera material produced the weakest bonds to Isosit-N resin. Surface treatment of Isosit-N veneers resulted in bond strength changes. Sandblasting reduced the force required for bond failure; Special Bond resin increased it slightly. Improving retention of prefabricated resin veneers proved difficult. Etched hybrid resin veneers delivered higher bond strengths than micro-filled resin veneers but not significantly. Etched porcelain veneers, however, provided consistently the strongest bond strengths with cohesive, as opposed to adhesive, bond failure.

Fracture toughness of chairside CAD/CAM materials - Alternative loading approach for compact tension test.

OBJECTIVE This in-vitro study determined plane-strain fracture toughness (KIC) of five different chairside CAD/CAM materials used for crown fabrication, following alternative innovative loading approach of compact tension test specimens. METHODS Rectangular-shaped specimens were cut from CAD/CAM blocks (n=10): Vita Mark II (Vident) (VMII); Lava-Ultimate (3M/ESPE) (LU); Vita Enamic (Vident) (VE); IPS e.max CAD (Ivoclar Vivadent); crystallized and un-crystallized (E-max and E-max-U, respectively); and Celtra Duo (Dentsply) fired and unfired (CD and CD-U, respectively). Specimens were notched with thin diamond disk prior to testing. Instead of applying tensile loading through drilled holes, a specially-made wedge-shaped steel loading-bar was used to apply compressive load at the notch area in Instron universal testing machine. The bar engaged the top ¼ of the notch before compressive load was applied at a cross-head speed of 0.5mm/min. Fracture load was recorded and KIC calculated. Data was statistically-analyzed with one-way ANOVA at 95% confidence level and Tukeys tests. RESULTS Means and SDs of KIC in MPam(1/2) for VMII, LU, VE, E-max, E-max-U, CD and CD-U were: 0.73 (0.13), 0.85 (0.21), 1.02 (0.19), 1.88 (0.62), 0.81 (0.25), 2.65 (0.32) and 1.01 (0.15), respectively. ANOVA revealed significant difference among the groups (p<0.001). CD and E-max had significantly highest mean KIC values. SIGNIFICANCE Mean KIC values of the tested materials varied considerably, however, none of them reached mean KIC of dentin (3.08MPam(1/2)) previously reported. For E-max and CD, specimens firing significantly increased mean KIC. The modified test arrangement was found to be easy to follow and simplified specimen preparation process.

The Effect of Bleaching Time on Dentin Fracture Toughness in Vitro

STATEMENT OF PROBLEM A recent study reported a decrease in dentin fracture toughness after the application of peroxide bleaching products to dentin in vitro. PURPOSE The objective of the present study was to investigate this in vitro decrease in fracture toughness further by evaluating the effect of different peroxide application times on dentin fracture toughness. MATERIALS AND METHODS Compact test fracture toughness specimens were prepared from coronal human. These were divided into five groups (N = 12) and subjected to either bleach (10% carbamide peroxide) and/or placebo gel for a total of 336 consecutive hours (0 and 336, 84 and 252, 168 and 168, 252 and 84, 336 and 0 hours of bleach and placebo application time, respectively). The gel materials were changed every 6 hours. Fracture toughness testing was done 24 hours after the end of bleaching using tensile loading at 10 mm/min. Results were analyzed by analysis of variance and linear regression (p < 0.05). RESULTS Dentin fracture toughness after 252 and 336 hours was significantly reduced compared to the 0- and 84-hour bleach times. An association between fracture toughness and bleach time (r(2) = 0.82) with an inverse linear regression line (K(1C) = -0.0032 [hour] + 3.386) was found. CONCLUSIONS A significant correlation was found between bleach time and dentin fracture toughness. Dentin fracture toughness was reduced over time during the 336-hour course of in vitro bleaching. CLINICAL SIGNIFICANCE The results suggest that it would be prudent to minimize the length of time for clinical bleaching procedures when dentin is directly exposed to bleach.

Matrix metalloproteinase inhibitor modulates esterase-catalyzed degradation of resin-dentin interfaces.

OBJECTIVE Assess the modulating effect of matrix metalloproteinase (MMP) inhibition on simulated human salivary enzyme (SHSE)-catalyzed degradation of interfacial fracture-toughness (FT) of self-etched and total-etched resin-dentin interfaces. METHODS Miniature short-rod FT specimens (N=10/group) containing a resin composite bonded to human dentin, using a self-etch (Easy Bond, EB) or a total-etch (Scotchbond, SB) adhesives, were prepared with and without application of an MMP inhibitor (galardin). Specimens were non-incubated or incubated in phosphate buffered saline (PBS) or SHSE for 7, 30, 90, or 180-days. FT data were obtained using a universal testing machine. Incubation media were analyzed by high performance liquid chromatography (HPLC) for the presence of a 2,2-bis-[4-2(2-hydroxy-3-methacryloxypropoxy)phenyl]-propane (bisGMA)-derived degradation product, bis-hydroxy-propoxy-phenyl-propane (bisHPPP). Fractographic analysis was performed by scanning electron microscopy and image processing software (ImageJ). Statistical analysis was performed by ANOVA and Tukeys (p<0.05). RESULTS More bisHPPP was detected in SHSE vs. PBS for both adhesive systems (p<0.05). EB specimens yielded no difference in FT and failed preferentially in the resin after >30-days (p<0.05). SB specimens yielded lower FT values after 180-days with SHSE ±galardin vs. 0-days/no-galardin (p<0.05) and failed preferentially in the hybrid-layer after >30-days (p<0.05). Galardin mildly modulated the change in fracture mode for both systems. SIGNIFICANCE Esterase-catalyzed degradation of total-etch interfaces is modulated by MMP-inhibition, however, self-etch interfaces possess greater biostability under simulated intra-oral conditions, regardless of MMP inhibition. This could be related to different chemical compositions and/or mode of adhesion.