Mutlu Özcan

Effect of surface conditioning methods on the bond strength of luting cement to ceramics

OBJECTIVES This study evaluated the effect of three different surface conditioning methods on the bond strength of a Bis-GMA based luting cement to six commercial dental ceramics. METHODS Six disc shaped ceramic specimens (glass ceramics, glass infiltrated alumina, glass infiltrated zirconium dioxide reinforced alumina) were used for each test group yielding a total number of 216 specimens. The specimens in each group were randomly assigned to one of the each following treatment conditions: (1) hydrofluoric acid etching, (2) airborne particle abrasion, (3) tribochemical silica coating. The resin composite luting cement was bonded to the conditioned and silanized ceramics using polyethylene molds. All specimens were tested at dry and thermocycled (6.000, 5-55 degrees C, 30 s) conditions. The shear bond strength of luting cement to ceramics was measured in a universal testing machine (1 mm/min). RESULTS In dry conditions, acid etched glass ceramics exhibited significantly higher results (26.4-29.4 MPa) than those of glass infiltrated alumina ceramics (5.3-18.1 MPa) or zirconium dioxide (8.1 MPa) (ANOVA, P<0.001). Silica coating with silanization increased the bond strength significantly for high-alumina ceramics (8.5-21.8 MPa) and glass infiltrated zirconium dioxide ceramic (17.4 MPa) compared to that of airborne particle abrasion (ANOVA, P<0.001). Thermocycling decreased the bond strengths significantly after all of the conditioning methods tested. SIGNIFICANCE Bond strengths of the luting cement tested on the dental ceramics following surface conditioning methods varied in accordance with the ceramic types. Hydrofluoric acid gel was effective mostly on the ceramics having glassy matrix in their structures. Roughening the ceramic surfaces with air particle abrasion provided higher bond strengths for high-alumina ceramics and the values increased more significantly after silica coating/silanization.

Influence of various surface-conditioning methods on the bond strength of metal brackets to ceramic surfaces

With the increase in adult orthodontic treatment comes the need to find a reliable method for bonding orthodontic brackets onto metal or ceramic crowns and fixed partial dentures. In this study, shear bond strength and surface roughness tests were used to examine the effect of 4 different surface conditioning methods: fine diamond bur, sandblasting, 5% hydrofluoric acid, and silica coating for bonding metal brackets to ceramic surfaces of feldspathic porcelain. Sandblasting and hydrofluoric acid were further tested after silane application. A total of 120 ceramic disc samples were produced, and 50 were used for surface roughness measurements. The glazed ceramic surfaces were used as controls. Metal brackets were bonded to the ceramic substrates with a self-curing composite. The samples were stored in 0.9% NaCl solution for 24 hours and then thermocycled (5000 times, 5 degrees C to 55 degrees C, 30 seconds). Shear bond tests were performed with a universal testing device, and the results were statistically analyzed. Chemical surface conditioning with either hydrofluoric acid (4.3 microm) or silicatization (4.4 microm) resulted in significantly lower surface roughness than mechanical conditioning (9.3 microm, diamond bur; 9.7 microm, sandblasting) (P <.001). The surface roughness values reflect the mean peak-and-valley distances. The bond strengths of the brackets bonded to the ceramic surfaces treated by hydrofluoric acid with and without silane (12.2 and 14.7 MPa, respectively), silicatization (14.9 MPa), and sandblasting with silane (15.8 MPa) were significantly higher (P <.001) than those treated by mechanical roughening with fine diamond burs (1.6 MPa) or sandblasting (2.8 MPa). The highest bond strength values were obtained with sandblasting and silicatization with silane or hydrofluoric acid without silane; these fulfilled the required threshold. The use of silane after hydrofluoric acid etching did not increase the bond strength. Diamond roughening and sandblasting showed the highest surface roughness; they can damage the ceramic surface. Acid etching gave acceptable results for clinical use, but the health risks should be considered. The silicatization technique has the potential to replace the other methods; yet cohesive failures were observed in the ceramic during removal of the brackets.

Titanium as a Reconstruction and Implant Material in Dentistry: Advantages and Pitfalls

Commercial pure titanium (cpTi) has been the material of choice in several disciplines of dentistry due to its biocompatibility, resistance to corrosion and mechanical properties. Despite a number of favorable characteristics, cpTi as a reconstruction and oral implant material has several shortcomings. This paper highlights current knowledge on material properties, passive oxidation film formation, corrosion, surface activation, cell interactions, biofilm development, allergy, casting and machining properties of cpTi for better understanding and potential improvement of this material for its clinical applications.

Two-body wear of monolithic, veneered and glazed zirconia and their corresponding enamel antagonists

OBJECTIVE This study tested whether the two-body wear of monolithic zirconia and their corresponding enamel antagonists was higher compared to monolithic alloy and veneered zirconia. MATERIALS AND METHODS Cylindrical specimens (N = 36, n = 6) were prepared out of (A) veneered zirconia (VZ), (B) glazed zirconia using a glaze ceramic (GZC), (C) glazed zirconia using a glaze spray (GZS), (D) manually polished monolithic zirconia (MAZ), (E) mechanically polished monolithic zirconia (MEZ) and (F) monolithic base alloy (control group, MA). Wear tests were performed in a chewing simulator (49 N, 1.7 Hz, 5°C/50°C) with enamel antagonists. The wear analysis was performed using a 3D profilometer before and after 120,000, 240,000, 640,000 and 1,200,000 masticatory cycles. SEM images were used for evaluating wear qualitatively. The longitudinal results were analysed using linear mixed models (α = 0.05). RESULTS Materials (p < 0.001) and number of masticatory cycles (p < 0.001) had a significant effect on the wear level. The least enamel antagonist wear was observed for MAZ and MEZ (27.3 ± 15.2, 28 ± 11.1 μm, respectively). GZC (118 ± 30.9 μm) showed the highest wear of enamel antagonists. The highest wear rate in the material was observed in GZS (91.3 ± 38.6 μm). While in the groups of MA, VZ, GZC and GZS 50% of the specimens developed cracks in enamel, it was 100% in MAZ and MEZ groups. CONCLUSION Polished monolithic zirconia showed lower wear rate on enamel antagonists as well as within the material itself but developed higher rates of enamel cracks.

Possible hazardous effects of hydrofluoric acid and recommendations for treatment approach: a review

Hydrofluoric acid (HF) is commonly used for conditioning the glass ceramics either prior to cementation or for intraoral repair in prosthetic and restorative dentistry. The present study offers a review of chemical properties of HF used, highlight the possible hazardous effects of this agent, and to recommend the treatment approach for potential risks. Available published information documented in PubMed, Medline, and Picarta literature databases was reviewed. Additional information was derived from scientific reports, medical and chemical textbooks, handbooks, product information, manufacturers’ instructions, Internet web sites of the HF manufacturers. No report was found on the incidence of the hazardous effects of HF in dentistry. Reports from other fields presented incidences of acute and chronic symptoms in exposure to HF. While acute symptoms include skin or nail burns, chronic ones involve systemic toxicity, eye injuries, inhalation and ingestion-related symptoms that can be even fatal. HF can be harmful and particularly aggressive to soft tissues, but symptoms may not be apparent immediately after exposure. The hazardous effects are not based on the pH value, but on the toxicity of HF. Potential hazards of HF known from other applications than dentistry should be considered also in dental applications. Especially the clinicians, who often deal with adhesive cementation or repair of glass ceramics, should take necessary precautions for possible hazards of HF.

Immediate repair bond strengths of microhybrid, nanohybrid and nanofilled composites after different surface treatments

OBJECTIVES To evaluate immediate repair bond strengths and failure types of resin composites with and without surface conditioning and characterize the interacting composite surfaces by their surface composition and roughness. METHODS Microhybrid, nanohybrid and nanofilled resin composites were photo-polymerized and assigned to four groups: (1) no conditioning (Control), (2) no conditioning, polymerized against a Mylar strip (Control, with strip), (3) intermediate adhesive resin (IAR) application, and (4) chair-side silica coating, silanization and intermediate resin application (SC). Resin composites, similar as their substrates, were adhered onto the substrates. Shear force was applied to the interface in a universal testing machine and failure types were evaluated under light microscopy. Surface characterization was done by contact angle measurements, X-ray photoelectron spectroscopy, scanning electron and atomic force microscopy. RESULTS Significant effects of the resin composite type and surface conditioning were observed. Conditioning the composites with their IARs does not result in significant improvements in bond strength compared to the control with strip (bond strengths between 14.5 and 20.0 MPa). SC increased the bond strength in all composites except TE by an average 8.9 MPa, while in all composites the surface roughness increased from 7 to 384 microm. Failure types in this group were exclusively cohesive. Physico-chemical modelling of the composite surfaces showed that the surfaces were dominated by the resin matrix, with a major increase in silica-coverage after SC for all composites. CONCLUSION Intermediate adhesive resin conditioning did not improve the composite-to-composite immediate repair strength. Silica coating and silanization followed by its corresponding IAR, strongly increased repair bond strengths and provided exclusively cohesive failures in the substrate in all composites.

Gender Difference in Prevalence of Signs and Symptoms of Temporomandibular Joint Disorders: A Retrospective Study on 243 Consecutive Patients

Background: This study evaluated the prevalence of the signs and symptoms of temporomandibular joint disorder (TMD) among patients with TMD symptoms. Methods: Between September 2011 and December 2011, 243 consecutive patients (171 females, 72 males, mean age 41 years) who were referred to the Department of Prosthodontics, Faculty of Dentistry, Karadeniz Technical University, Trabzon were examined physically and completed a questionnaire regarding age, gender, social status, general health, antidepressant drug usage, dental status, limited mouth opening, temporomandibular joint (TMJ) sounds, and parafunctions (bruxism, clenching). The data were analyzed using the chi-square test and binary logistic regression model (alpha = 0.05). Results: With a frequency of 92%, pain in the temporal muscle was the most common symptom, followed by pain during mouth opening (89%) in both genders. TMJ pain at rest, pain in the masseter muscle, clicking, grinding, and anti-depressant use were significantly more frequent in females than males. Age (p=0.006; odds ratio 0.954; 95% CI 0.922-0.987) and missing teeth (p=0.003; odds ratio 3.753; 95% CI 1.589-8.863) had significant effects on the prevalence of TMD. Conclusion: Females had TMD signs and symptoms more frequently than males in the study population. The most common problem in both genders was pain.

A comparative study between cone‐beam computed tomography and periapical radiographs in the diagnosis of simulated endodontic complications

AIM To compare cone-beam computed tomography (CBCT) with periapical radiography for the identification of simulated endodontic complications. METHODOLOGY Sixteen human teeth, in three mandibles, were submitted to the following simulated endodontic complications: G1) fractured endodontic file; G2) root perforation; G3) cast post with deviation; G4) external root resorption. Periapical radiographs were taken of each tooth at three different angles, and CBCT scan was taken. One calibrated examiner who was specialized in dental radiology interpreted the images. The results were analysed using the following scoring system: 0 - unidentified alteration; 1 - alteration identified with inaccurate diagnosis; and 2 - alteration identified with accurate diagnosis. Data were analysed using McNemar and Wilcoxon tests (alfa=0.05). RESULTS In the overall assessment, CBCT was superior when compared with periapical radiographs (P<0.05). When individual results on each complication were evaluated, CBCT was superior only in the identification of external root resorption (100% Score 2) (P<0.05). CONCLUSION Cone-beam computed tomography could be an alternative to periapical radiographs especially in the detection and assessment of external root resorption.

Effect of air-particle abrasion protocols on the biaxial flexural strength, surface characteristics and phase transformation of zirconia after cyclic loading

This study evaluated the effect of air-particle abrasion protocols on the biaxial flexural strength, surface characteristics and phase transformation of zirconia after cyclic loading. Disc-shaped zirconia specimens (Ø: 15mm, thickness: 1.2mm) (N=32) were submitted to one of the air-particle abrasion protocols (n=8 per group): (a) 50μm Al2O3 particles, (b) 110μm Al2O3 particles coated with silica (Rocatec Plus), (c) 30μm Al2O3 particles coated with silica (CoJet Sand) for 20s at 2.8bar pressure. Control group received no air-abrasion. All specimens were initially cyclic loaded (×20,000, 50N, 1Hz) in water at 37°C and then subjected to biaxial flexural strength testing where the conditioned surface was under tension. Zirconia surfaces were characterized and roughness was measured with 3D surface profilometer. Phase transformation from tetragonal to monoclinic was determined by Raman spectroscopy. The relative amount of transformed monoclinic zirconia (FM) and transformed zone depth (TZD) were measured using XRD. The data (MPa) were analyzed using ANOVA, Tukeys tests and Weibull modulus (m) were calculated for each group (95% CI). The biaxial flexural strength (MPa) of CoJet treated group (1266.3±158(A)) was not significantly different than that of Rocatec Plus group (1179±216.4(A,B)) but was significantly higher than the other groups (Control: 942.3±74.6(C); 50μm Al2O3: 915.2±185.7(B,C)). Weibull modulus was higher for control (m=13.79) than those of other groups (m=4.95, m=5.64, m=9.13 for group a, b and c, respectively). Surface roughness (Ra) was the highest with 50μm Al2O3 (0.261μm) than those of other groups (0.15-0.195μm). After all air-abrasion protocols, FM increased (15.02%-19.25%) compared to control group (11.12%). TZD also showed increase after air-abrasion protocols (0.83-1.07μm) compared to control group (0.59μm). Air-abrasion protocols increased the roughness and monoclinic phase but in turn abrasion with 30μm Al2O3 particles coated with silica has increased the biaxial flexural strength of the tested zirconia.

Effect of silica coating combined to a MDP-based primer on the resin bond to Y-TZP ceramic

The aim of this study was to evaluate the influence of silica coating and 10-methacryloyloxydecyl dihydrogen phosphate (MDP)-based primer applications upon the bonding durability of a MDP-based resin cement to a yttrium stabilized tetragonal zirconia (Y-TZP) ceramic. Ninety-six Y-TZP tabs were embedded in an acrylic resin (free surface for adhesion: 5 × 5 mm(2)), ground finished and randomly divided into four groups (N = 24) according to the ceramic surface conditioning: (1) cleaning with isopropanol (ALC); (2) ALC + phosphoric acid etching + MDP-based primer application (MDP-primer); (3) silica coating + 3-methacryloyloxypropyl trimethoxysilane (MPS)-based coupling agent application (SiO2 + MPS-Sil); and (4) SiO2 + MDP-primer. The MDP-based resin cement was applied on the treated surface using a cylindrical mold (diameter= 3 mm). Half of the specimens from each surface conditioning were stored in distilled water (37 °C, 24 h) before testing. Another half of the specimens were stored (90 days) and thermo-cycled (12,000 x) during this period (90 d/TC) before testing. A shear bond strength (SBS) test was performed at a crosshead speed of 0.5 mm/min. Two factors composed the experimental design: ceramic conditioning strategy (in four levels) and storage condition (in two levels), totaling eight groups. After 90 d/TC (Tukey; p < 0.05), SiO2 + MDP-primer (24.40 MPa) promoted the highest SBS. The ALC and MDP-primer groups debonded spontaneously during 90 d/TC. Bonding values were higher and more stable in the SiO2 groups. The use of MDP-primer after silica coating increased the bond strength.