Mario Fernando de Goes

Effect of etching and airborne particle abrasion on the microstructure of different dental ceramics

STATEMENT OF PROBLEM The ceramic composition and microstructure surface of all-ceramic restorations are important components of an effective bonding substrate. Both hydrofluoric acid etching and airborne aluminum oxide particle abrasion produce irregular surfaces necessary for micromechanical bonding. Although surface treatments of feldspathic and leucite porcelains have been studied previously, the high alumina-containing and lithium disilicate ceramics have not been fully investigated. PURPOSE The purpose of this study was to assess the surface topography of 6 different ceramics after treatment with either hydrofluoric acid etching or airborne aluminum oxide particle abrasion. MATERIAL AND METHODS Five copings each of IPS Empress, IPS Empress 2 (0.8 mm thick), Cergogold (0.7 mm thick), In-Ceram Alumina, In-Ceram Zirconia, and Procera (0.8 mm thick) were fabricated following the manufacturers instructions. Each coping was longitudinally sectioned into 4 equal parts by a diamond disk. The resulting sections were then randomly divided into 3 groups depending on subsequent surface treatments: Group 1, specimens without additional surface treatments, as received from the laboratory (control); Group 2, specimens treated by use of airborne particle abrasion with 50-microm aluminum oxide; and Group 3, specimens treated with 10% hydrofluoric acid etching (20 seconds for IPS Empress 2; 60 seconds for IPS Empress and Cergogold; and 2 minutes for In-Ceram Alumina, In-Ceram Zirconia, and Procera). RESULTS Airborne particle abrasion changed the morphologic surface of IPS Empress, IPS Empress 2, and Cergogold ceramics. The surface topography of these ceramics exhibited shallow irregularities not evident in the control group. For Procera, the 50-microm aluminum oxide airborne particle abrasion produced a flattened surface. Airborne particle abrasion of In-Ceram Alumina and In-Ceram Zirconia did not change the morphologic characteristics and the same shallows pits found in the control group remained. For IPS Empress 2, 10% hydrofluoric acid etching produced elongated crystals scattered with shallow irregularities. For IPS Empress and Cergogold, the morphologic characteristic was honeycomb-like on the ceramic surface. The surface treatment of In-Ceram Alumina, In-Ceram Zirconia, and Procera did not change their superficial structure. CONCLUSION Hydrofluoric acid etching and airborne particle abrasion with 50-microm aluminum oxide increased the irregularities on the surface of IPS Empress, IPS Empress 2, and Cergogold ceramics. Similar treatment of In-Ceram Alumina, In-Ceram Zirconia, and Procera did not change their morphologic microstructure.

Effect of curing mode on the polymerization characteristics of dual-cured resin cement systems

OBJECTIVES To evaluate the effects of different curing conditions on the degree of conversion (DC) of dual-cured cementing systems [combination of bonding agent (BA) and resin cement (RC)] using infrared spectroscopy. METHODS Four fourth generation products [Scotchbond Multipurpose Plus/RelyX (3M ESPE), Optibond/Nexus 2 (Kerr), All Bond2/Duolink (Bisco), and Bond-It!/Lute-It! (Pentron)], and three fifth generation materials [Bond1/Lute-It! (Pentron), Prime&Bond NT Dual-Cure/Calibra (Dentsply), and Optibond Solo Dual Cure/Nexus 2 (Kerr)] were applied to the surface of a horizontal attenuated-total-reflectance unit, and were polymerized using one of four conditions: self-cure (SC), direct light exposure through glass slide (DLE, XL3000/3M ESPE) or through pre-cured resin discs (shades A2;A4/2mm thick/Z250/3M ESPE). Infrared spectra of the uncured cementing systems were recorded immediately after application to the ATR, after the system was light-cured or left to self-cure, and spectra were obtained 5 and 10 min later. DC was calculated using standard techniques of observing changes in aliphatic-to-aromatic peak ratios pre- and post-curing. Data (n=5) were analyzed by two-way repeated measures ANOVA and Tukeys test (p=0.05). RESULTS Changes in aliphatic-to-aromatic peak ratios before and after placing RC onto the BA demonstrated that a combined layer was created. All groups exhibited higher DC after 10 min than after 5 min, except the DLE group of Bond-it!/Lute-it!. No significant differences in DC were observed among light-activated groups regardless of the resin disc shade in three of the four fourth generation cementing systems. The SC groups exhibited lower DC than the DLE groups for both fourth and fifth generation products either after 5 or 10 min. CONCLUSION The chemistry of the bonding interface changed when RCs were applied to uncured BAs. The presence of an indirect restoration can decrease the DC of some cementing systems and the self-curing mode leads to lower DC than the light-activating one.

A morphological and tensile bond strength evaluation of an unfilled adhesive with low-viscosity composites and a filled adhesive in one and two coats.

OBJECTIVE The purpose of this study was to measure the tensile bond strength (TBS) testing of resin composite to dentin of three low-viscosity composites, in association with an unfilled adhesive, and a filled adhesive one and two coats respectively, and to evaluate and compare the SEM morphological observations. METHODS The labial surface of 120 bovine lower incisors were ground to obtain a flat dentin surface allowing demarcation of a 4 mm diameter area with adhesive tape. The teeth were randomly divided in six groups of 20 each. The dentin of each ground surface was etched with 35% H(3)PO(4) for 15s, followed by application of the respective adhesive: Single Bond (SB) for Groups 1, 2, 3 and 6; Optibond Solo (OS) for Groups 4 and 5. In Groups 1 and 4, a resin composite rod with a wire loop was luted directly to the adhesive surface with Z100. Group 2 received an intermediate layer of Flow It (FI) composite; Group 3 received an intermediate layer of Protect Liner F (PLF) composite; Group 5 received a second coat of OS; and Group 6 received an intermediate layer of an experimental low-viscosity composite (EM). A resin composite rod was luted to the surface of each specimen with Z100 resin composite. All specimens were stored in distilled water at 37 degrees C for 24h prior to TBS testing. Each specimen was inspected by SEM and classified according to adhesive or cohesive failure mode. One specimen of each group was cut longitudinally, polished and prepared for SEM observation. RESULTS The TBS values were: Group 1 (7.86MPa+/-2.28), Group 2 (7.62MPa+/-1.85), Group 3 (7.60MPa+/-2.14), Group 4 (7.96MPa+/-2.36), Group 5 (7.50MPa+/-2.70) and Group 6 (7.18MPa+/-2.40). No significant statistical differences were observed among the groups. However, the analyses of the failure mode presented a considerable variation. SIGNIFICANCE The use of a filled adhesive or an unfilled adhesive along with a low-viscosity composite as an intermediate layer may provide a stress absorbing layer, whereby improving the preservation of the bonded interface area.

Effectiveness of self-adhesive luting cements in bonding to chlorhexidine-treated dentin

OBJECTIVES The aim was to investigate the microtensile bond strength (μ-TBS) and failure pattern of self-adhesive luting cements (SLC) to dentin pre-treated with different concentrations of chlorhexidine (CHX) solutions. METHODS The occlusal enamel was removed from 30 extracted sound human molars in order to expose a flat dentin. Resin-composite (Filtek Z250, 3M ESPE) discs (12 mm in diameter, 6.0mm thickness) were cemented to the smear layer-covered dentin using the SLC [RelyX U100, 3M ESPE (U100); Multilink Sprint, Ivoclar Vivadent (MS)] with 0.2% or 2.0% CHX solutions. Results were compared with the control, untreated dentin. Six groups were then created based on the SLC and dentin pre-treatment (n=5). After 24h of water storage, restored teeth were serially sectioned into beams with a cross-sectional area of 0.8mm(2) at the bonded interface. Subsequently, specimens were tested in tension with a crosshead speed of 0.5mm/min in a universal testing machine, and the failure patterns were classified. Two-way ANOVA and Tukeys tests were performed (α=0.05). Additionally, 18 teeth were subjected to energy-dispersive X-ray spectroscopy (EDS) analysis and micromorphology characterization of the smear layer-covered dentin and 0.2% or 2.0% CHX-treated dentin surfaces. RESULTS The μ-TBS obtained for both control groups were significantly higher, regardless of the CHX concentration and/or the cement used. Bond strengths were significantly higher for U100 than for MS, except when 2.0% CHX was applied. Fractographic analysis indicated that most failures in the control groups occurred cohesively in the SLC. Pre-treated dentin with 0.2% and 2.0% CHX solutions presented higher incidences of adhesive failures. EDS/SEM analysis exhibited varied concentrations of chlorine ions and crystal-shaped precipitates, depending upon the CHX concentration. SIGNIFICANCE Pre-treatment of dentin with 0.2% or 2.0% CHX adversely affects the bonding efficacy when associated with the SLCs tested.

Fluoride-containing adhesive: durability on dentin bonding.

OBJECTIVES To evaluate (1) the influence of fluoride-containing adhesive on microtensile bond strength (microTBS) and (2) in vitro secondary caries inhibition at the resin-dentin interface after 24 h and 3 months water-storage and (3) the degree of conversion of different adhesives after 24h 1 month. METHODS Flat surfaces of human teeth were ground and randomly assigned to six groups: (SBMP-24) Scotchbond Multi-Purpose control [SBMP], 24 h; (SE-24) SBMP etch and primer+Clearfil SE Bond adhesive [SE], 24h; (PB-24) SBMP etch and primer+Clearfil Protect Bond adhesive [PB], 24h; (SBMP-3) SBMP, 3 months; (SE-3) SBMP+SE, 3 months; and (PB-3) SBMP+PB, 3 months. To evaluate the effect of the adhesive resin alone, all teeth were etched with 35% phosphoric acid and primed with SBMP primer prior to applying the adhesive resin. Bonded assemblies were prepared for microTBS and stored in distilled water at 37 degrees C for 24h and 3 months. Sections of restored teeth of each group were exposed to an acid challenge. The specimens were sectioned, polished, and then observed with polarized light microscopy (PLM). Also, the degree of conversion (DC) of the adhesives was measured using Fourier Transform-Infrared spectroscopy (FTIR) at 24 h and 1 month, after polymerization. RESULTS microTBS values obtained in MPa (24h/3m) were: (MP) 61.5+/-10.5/52.9+/-8.9, (SE) 55.5+/-11.8/55.6+/-13, and (PB) 50.3+/-9.9/61.0+/-13.6. For interface analysis by PLM, an inhibition zone (IZ) adjacent to the hybrid layer was created only when the fluoride-containing adhesive (PB) was used. The DC in percentage (24 h, 1 month) were: (MP) 60.5+/-2.8/61.3+/-0.6, (SE) 69.6+/-1.3/70.7+/-0.05, and (PB) 53.1+/-0.4/58.3+/-1.6. SIGNIFICANCE The fluoride-containing adhesive demonstrated significant increase of bond strength values after water-storage. This material was also able to create an acid inhibition zone in dentin. There was a significant increase of degree of conversion after 1 month only for PB.

Bond strength and interfacial micromorphology of etch-and-rinse and self-adhesive resin cements to dentin.

PURPOSE To evaluate the microtensile bond strength and interfacial micromorphology of indirect composite restorations to dentin using three commercial resin cements after 24 hours and 30 days of water storage. MATERIALS AND METHODS The medium dentin of third human molars was exposed (N = 30, n = 10 per group). Three commercial resin cements were used to cement indirect resin composite restorations to dentin: the auto-cured C&B Cement/All Bond 2, the dual-cured RelyX ARC/Adper Single Bond 2, and the self-adhesive dual-cured RelyX Unicem. Teeth were sectioned after water storage at 37°C (24 hours and 30 days) to obtain beams with a bonded area of 0.8 mm(2) . The specimens were tested in a universal testing machine at a 0.5 mm/min crosshead speed. Scanning electron microscopic fractographic and interfacial micromorphology analyses were performed. Data were analyzed using two-way ANOVA and Tukeys test (α= 0.05). RESULTS Mean bond strength (MPa) after 24 hours: C&B Cement 19.5 ± 3.8, RelyX ARC 40.8 ± 9.4, RelyX Unicem 31.3 ± 7.4; after 30 days: C&B Cement 24.5 ± 5.1, RelyX ARC 44.2 ± 8.5, RelyX Unicem 28.3 ± 7.1. The mean bond strengths of both dual-cure cements were significantly higher than that obtained with C&B Cement after 24 hours. A significant increase in the bond strength of C&B Cement was verified after 30 days, reaching values statistically equivalent to those produced by RelyX Unicem and RelyX ARC. The self-adhesive cement preserved the same level of bond strength after 30 days. Fractographic analysis revealed a prevalence of cohesive fractures in the hybrid layer for C&B Cement, mixed (cohesive in the cement, hybrid layer, and adhesive) for RelyX ARC, and cohesive in the cement for RelyX Unicem. No distinguishable hybrid layer or resin tags were observed in the interaction of RelyX Unicem with dentin. CONCLUSIONS The particular interaction of each cement with dentin results in specific bond strength and failure patterns that varied among groups in both evaluation times. Even though the self-adhesive cement tested exhibited no authentic hybrid layer, it was able to promote reliable adhesion with the underlying dentin.

Patterns of Demineralization and Dentin Reactions in Radiation-Related Caries

Radiation-related caries is a unique form of rampant decay and is a complication of head and neck radiotherapy that frequently causes generalized dental destruction and impairs quality of life in cancer patients. The aim of this study was to investigate the patterns of demineralization of caries in irradiated patients and to establish whether direct radiogenic damage to the dentition might be important in the progression of radiation-related caries. Teeth from patients who had concluded radiotherapy were examined histologically by polarized light microscopy, and the ultrastructure was examined by scanning backscattered electron microscopy. Cervical caries and incisal caries, a very unusual sort of lesion, were widely detected. Additionally, diffuse brown discoloration of the smooth surface of enamel was frequently observed. Polarized light microscopy suggested that these areas were incipient caries. Evidence of normal odontoblast function was observed in the detection of reactionary dentin and intratubular dentin deposition. In conclusion, radiation-related caries seems to have the same morphological and demineralization pattern as ordinary caries, with the presence of demineralized dentin, a translucent zone, dentin dead tracts, reactionary dentin and intratubular dentin deposition. Based on these findings, direct radiogenic destruction of the teeth seems to be not essential to the microscopic progression of radiation-related caries.

Microhardness of resin cements in the intraradicular environment: Effects of water storage and softening treament

OBJECTIVES To analyze the microhardness of four dual-cure resin cements used for cementing fiber-reinforced posts under the following conditions: after 7 days of storage in water, after additional 24h of immersion in 75% ethanol, and after 3 months of storage in water. Hardness measurements were taken at the cervical, middle and apical thirds along the cement line. METHODS Root canals of 40 bovine incisors were prepared for post space. Fibrekor glass fiber-reinforced posts (Jeneric/Pentron) of 1mm in diameter were cemented using Panavia F 2.0 (Kuraray), Variolink (Ivoclar-Vivadent), Rely X Unicem (3M ESPE) or Duolink (Bisco) (N=10). After 7 days of water storage at 37 degrees C, half the sample (N=5) was longitudinally sectioned and the initial microhardness measured along the cement line from cervical to apex. These same samples were further immersed in 75% ethanol for 24h and reassessed. The remaining half (N=5) was kept unsectioned in deionized water at 37 degrees C for 3 months, followed by sectioning and measuring. Data were analyzed by a series of two-way ANOVA and Tukey tests at alpha=5%. RESULTS Statistically significant differences were identified among the cements, thirds and conditions. Significant interactions were also observed between cements and thirds and between cements and conditions. Panavia F exhibited significantly higher initial microhardness than the other three cements, which showed no statistical difference among themselves. Variolink and Duolink showed significantly higher microhardness values in the cervical third, without significant difference among the thirds for the other cements. Immersion in ethanol significantly reduced the hardness values for all cements, regardless of the thirds. Storage in water for 3 months had no influence on the hardness of most of the cements, with the exception of Unicem that showed a significant increase in the hardness values after this period. SIGNIFICANCE Results showed heterogeneity in the microhardness of the cements inside the canal. All cements presented some degree of softening after ethanol treatment, which suggests instability of the polymer. The quality of curing of resin cements in the root canal environment seems unpredictable and highly material dependent.

Adhesive systems: important aspects related to their composition and clinical use

This literature review article addresses the types and the main components of different etch-and-rinse and self-etch adhesive systems available in the market, and relates them to their function, possible chemical interactions and influence of handling characteristics. Scanning electron microscopy (SEM) images are presented to characterize the interface between adhesives and dentin. Adhesive systems have been recently classified according to their adhesion approaches in etch-and-rinse, self-etch and glass ionomer. The etch-andrinse systems require a specific acid-etch procedure and may be performed in two or three steps. Self-etch systems employ acidic monomers that demineralize and impregnate dental substrates almost at the same time. These systems are separated in one or two steps. Some advantages and deficiencies were noted for etch-and-rinse and self-etch approaches, mainly for the simplified ones due to some chemical associations and interactions. The SeM micrographs illustrate different relationships between adhesive systems and dental structures, particularly dentin. The knowledge of composition, characteristics and mechanisms of adhesion of each adhesive system is of fundamental importance to permit the adoption of ideal bonding strategies under clinical conditions.

Correlation between margin fit and microleakage in complete crowns cemented with three luting agents

Microleakage can be related to margin misfit. Also, traditional microleakage techniques are time-consuming. This study evaluated the existence of correlation between in vitro margin fit and a new microleakage technique for complete crowns cemented with 3 different luting agents. Thirty human premolars were prepared for full-coverage crowns with a convergence angle of 6 degrees, chamfer margin of 1.2 mm circumferentially, and occlusal reduction of 1.5 mm. Ni-Cr cast crowns were cemented with either zinc phosphate (ZP) (S.S. White), resin-modified glass-ionomer (RMGI) (Rely X Luting Cement) or a resin-based luting agent (RC) (Enforce). Margin fit (seating discrepancy and margin gap) was evaluated according to criteria in the literature under microscope with 0.001 mm accuracy. After thermal cycling, crowns were longitudinally sectioned and microleakage scores at tooth-cement interface were obtained and recorded at x100 magnification. Margin fit parameters were compared with the one-way ANOVA test and microleakage scores with Kruskal-Wallis and Dunns tests (α=0.05). Correlation between margin fit and microleakage was analyzed with the Spearmans test (α=0.05). Seating discrepancy and marginal gap values ranged from 81.82 μm to 137.22 μm (p=0.117), and from 75.42 μm to 78.49 μm (p=0.940), respectively. Marginal microleakage scores were ZP=3.02, RMGI=0.35 and RC=0.12 (p<0.001), with no differences between RMGI and RC scores. The correlation coefficient values ranged from -0.27 to 0.30 (p>0.05). Conclusion: Margin fit parameters and microleakage showed no strong correlations; cast crowns cemented with RMGI and RC had lower microleakage scores than ZP cement.