Ovul Kumbuloglu

Bonding of resin composite luting cements to zirconium oxide by two air-particle abrasion methods.

OBJECTIVE This study evaluated the shear bond strength of two resin composite luting cements to zirconium oxide ceramic substrate using two air-particle abrasion methods. METHODS Two resin composite cements, RelyX Unicem (3M ESPE) and Panavia F (Kuraray), each with an acidic composition, were used in combination with a zirconium oxide (DCS Dental AG) substrate containing Al2O3 and SiO2 (Rocatec system, 3M ESPE) and two air-particle abrasion methods. The shear bond strength of the resin composite cement to the substrate was tested after the samples were either water-stored for one week or thermocycled following 24 hours of water storage. RESULTS The RelyX Unicem resin composite cement specimens with the Rocatec treatment (20.9 +/- 4.6 Mpa and 20.1 +/- 4.2 MPa, respectively, n = 12) demonstrated the highest shear bond strength. Alternatively, the lowest values were obtained for the Panavia F resin cement samples, with Al2O3 air-particle abrasion in both storage conditions, water storage for one week (17.7 +/- 8.9MPa) or thermocycling after 24 hours of water storage (16.3 +/- 4.9 MPa). Neither storage condition or particle abrasion system significantly affected shear bond strengths (ANOVA, p > 0.05). CONCLUSION It was concluded that two different surface conditioning methods and storage conditions did not significantly affect the bonding properties of Panavia F and RelyX Unicem resin composite luting cements to Zirconia.

Intra‐oral adhesive systems for ceramic repairs: a comparison

The aim of this investigation was to compare the bond strength of restorative composite resin to dental ceramic conditioned with primers and adhesives of various commercial repair kits. Three intra‐oral ceramic repair systems—Silistor (Heraeus Kulzer), Cimara (Voco), Ceramic Repair (Vivadent)—were used on all‐ceramic (IPS Empress 2, Ivoclar‐Vivadent) substrate. Shear bond strength of restorative composite resin to substrate was tested after thermocycling and without thermocycling (n=10). Substrate surfaces of the specimen after loading were examined microscopically (SEM). The highest bond strengths in both water‐stored (7.0±5.7 MPa) and thermocycled conditions (2.5±1.8 MPa) were obtained with the Vivadent repair system, while the lowest values were observed with the Cimara system (0.6±1.4 MPa and 0.0±0.0 MPa, respectively). Shear bond strengths appeared to be significantly affected by thermocycling (ANOVA, P<0.05). It is concluded that there are significant differences in the bond strengths of resin composites and ceramic substrate. The roughened surface does not necessarily provide a better bond strength; the bond strength of composite decreases with storage in water and after thermocycling. Bond strength values were generally low for all of the tested materials.

Clinical survival of indirect, anterior 3-unit surface-retained fibre-reinforced composite fixed dental prosthesis: Up to 7.5-years follow-up

OBJECTIVES This prospective clinical study evaluated the performance of indirect, anterior, surface-retained, fibre-reinforced-composite restorations (ISFRCR). METHODS Between June-2003 and January-2011, a total of 134 patients (83 females, 51 males, 16-68 years old) received 175 ISFRCRs (local ethical registration number: 14/9/4). All restorations were made indirectly on a plaster model using unidirectional E-glass fibres (everStick C&B, StickTech) in combination with a laboratory resin composite (Dialogue, Schütz Dental) and cemented according to the instructions of 4 resin cements [(RelyX ARC, 3M-ESPE, n=61), Bifix DC, VOCO, n=45), Variolink II (Ivoclar Vivadent, n=32) and Multilink (Ivoclar Vivadent, n=37)]. After baseline recordings, patients were followed at 6 months and thereafter annually up to 7.5 years. The evaluation protocol involved technical (chipping, debonding or fracture of tooth/restoration) and biological failures (caries). RESULTS Mean observation period was 58 months. Altogether, 13 failures were observed [survival rate: 97.7%] (Kaplan-Meier). One catastrophic fracture [(cement: RelyX ARC), eight partial debonding (cement: Bifix DC (5), Multilink (1), RelyX ARC (1), Variolink II (1)] and four delaminations of veneering composite [(cement: Bifix DC (2), RelyX ARC (1), Multilink (1)] were observed. Except one replacement, all defective restorations were repaired or recemented. Annual failure rate of ISFRCRs was 1.73%. The survival rates with the four resin cements did not show significant differences (RelyX ARC: 98.3%; Bifix DC: 93.5%; Variolink 2: 100%; Multilink: 100%) (p=0.114). Secondary caries did not occur in any of the teeth. CONCLUSION The 3-unit anterior indirect surface-retained resin-bonded FRC FDPs showed similar clinical survival rate when cemented with the resin cements tested. Experienced failures in general were due to debonding of the restoration or delamination of the veneering composite. CLINICAL SIGNIFICANCE 3-unit surface retained resin-bonded FRC FDPs could be considered minimal invasive and cost-effective alternatives to conventional tooth- or implant-borne FDPs. Failures were mainly repairable in the form of chipping or debonding depending on the resin cement type.

Candida albicans adherence on silicone elastomers: Effect of polymerisation duration and exposure to simulated saliva and nasal secretion

OBJECTIVES The surfaces of maxillo-facial prostheses made of silicone elastomers exposed to soft tissues may interact with saliva and nasal secretion. These body fluids may lead to colonisation of microorganisms on their surfaces leading to their degradation or infection. This study investigated Candida albicans adhesion onto commercial maxillo-facial silicone elastomers based on different polymerisation processes. METHODS Room-temperature polymerised maxillo-facial silicone elastomers (N=48) (10 mm x 10 mm x 2 mm) processed at different durations [VerSilTal VST-30 (20 min), VST-50 (12h overnight), VST-50F (6h)] were studied. C. albicans was chosen as a model organism for this study. The specimens were randomly divided into two subgroups and incubated in either 1.5 ml simulated saliva or nasal secretion containing C. albicans (ATCC 60193, set to 0.5 OD, 540 nm in advance) for 2h. Candida assays and adherence assays were made by inoculating C. albicans into Mueller Hinton Broth, Fluka added 500 mmol sucrose overnight. After fixation, specimens were stained by using sterilised Methylene Blue stain (Merck) and evaluated under optical microscope and SEM. For each material, on each specimen 15 different areas (mm(2)) were counted. Data were analysed using one-way ANOVA, paired sample t-test and Tukeys HSD (alpha=0.05). RESULTS Material type (p<0.05) and exposure media (p<0.05) showed a significant influence on the C. albicans adherence. VST-30 material showed the most C. albicans adherence in both saliva and nasal secretion (mean rank: 99.84 and 53.47, respectively) (p<0.05) and VST-50 had the least colonisation in both media (10.35 and 5.57, respectively). Microscopic evaluation showed clusters of blastospore cells of C. albicans being more spread out on VST-30 whereas cells were more localised on VST-50 and VST-50F. SIGNIFICANCE Among the tested materials, 12h room-temperature polymerised silicone elastomer resulted in less C. albicans adherence in both artificial saliva and nasal secretion.

Bioactive glass particulate filler composite: Effect of coupling of fillers and filler loading on some physical properties

OBJECTIVES The aim of this study was to investigate the effect of silanization of biostable and bioactive glass fillers in a polymer matrix on some of the physical properties of the composite. METHODS The water absorption, solubility, flexural strength, flexural modulus and toughness of different particulate filler composite resins were studied in vitro. Five different specimen groups were analyzed: A glass-free control, a non-silanized bioactive glass, a silanized bioactive glass, a non-silanized biostable glass and a silanized biostable glass groups. All of these five groups were further divided into sub-groups of dry and water-stored materials, both of them containing groups with 3wt%, 6wt%, 9wt% or 12wt% of glass particles (n=8 per group). The silanization of the glass particles was carried out with 2% of gamma-3-methacryloxyproyltrimethoxysilane (MPS). For the water absorption and solubility tests, the test specimens were stored in water for 60 days, and the percentages of weight change were statistically analyzed. Flexural strength, flexural modulus and toughness values were tested with a three-point bending test and statistically analyzed. RESULTS Higher solubility values were observed in non-silanized glass in proportion to the percentage of glass particles. Silanization, on the other hand, decreased the solubility values of both types of glass particles and polymer. While 12wt% non-silanized bioactive glass specimens showed -0.98wt% solubility, 12wt% silanized biostable glass specimens were observed to have only -0.34wt% solubility. The three-point bending results of the dry specimens showed that flexural strength, toughness and flexural modulus decreased in proportion to the increase of glass fillers. The control group presented the highest results (106.6MPa for flexural strength, 335.7kPA for toughness, 3.23GPa for flexural modulus), whereas for flexural strength and toughness, 12wt% of non-silanized biostable glass filler groups presented the lowest (70.3MPa for flexural strength, 111.5kPa for toughness). For flexural modulus on the other hand, 12wt% of silanized biostable glass filler group gave the lowest results (2.57GPa). SIGNIFICANCE The silanization of glass fillers improved the properties of the glass as well as the properties of the composite. Silanization of bioactive glass may protect the glass from leaching at early stage of water storage.

Pilot study of unidirectional E-glass fibre-reinforced composite resin splints: Up to 4.5-year clinical follow-up

OBJECTIVES This prospective clinical pilot study evaluated the performance of fibre-reinforced-composite resin (FRC) splints on mandibular anterior teeth. METHODS Between June-2003 and January-2008, 19 patients (7 females, 12 males, 45-72 years old) from a group of consecutive patients who completed periodontal therapy received E-glass FRC splints (everStick Perio, StickTech) in combination with two types of flowable and restorative resin-composites (Filtek Flow, Filtek Supreme, n=11; Tetric Flow, Tetric-Ceram, n=8). Only patients with vital teeth, presenting mobility of grade 3, having at least one canine with no mobility on both sides of the dental arch were assigned for a splint therapy. The patients were recalled for periodical follow-up controls first at 6 months and thereafter annually. The evaluation protocol involved technical failures [chipping, debonding or fracture (tooth/restoration)] and biological failures (caries)]. Periodontal pocket depth (PPD) and clinical attachment level (CAL) were measured 6 months after splinting and annually. Six sites were measured for each natural tooth at the mesiobuccal, buccal, distobuccal, distolingual, lingual and mesiolingual sites. RESULTS All splints were applied from canine to canine in the mandible. In total, 5 recalls were performed and no drop-out was experienced. One partial debonding of the FRC splint with Tetric Flow/Tetric-Ceram combination was observed after 40 months. No caries was found around any of the splints and no teeth had to be extracted until the final follow up. The splinted teeth were found to be vital in the vitality tests. Overall survival rate was 94.8% (Kaplan-Meier). The survival rate was not significantly affected by the composite type (Filtek-Flow/Filtek Supreme: 100%, Tetric Flow/Tetric Ceram: 96% (p=0.92) [Kaplan-Meier, Log Rank (Mantel-Cox) (CI=95%)]. Hazard ratio for Tetric Flow/Tetric Ceram group was 0.05 (95% CI) and for Filtek Flow/Filtek Supreme group 0.00 (95% CI). Whilst overall PPD measurements of the dentition ranged between 6 and 12 mm, the CAL measurements ranged between 4.9 and 10mm at baseline. The mean PPD for the splinted teeth decreased from 8.9±1.8 mm to 5.2±1.2 mm, and CAL decreased from 7.2±1.6 mm to 4.6±1 mm at the end point. CONCLUSION Direct tooth splinting with E-glass FRC material performed successfully up to 4.5 years. Periodontal status of the splinted teeth showed decreased PPD and CAL.

Effect of composition, viscosity and thickness of the opaquer on the adhesion of resin composite to titanium.

OBJECTIVES The objectives of this study were to determine the bond strength of powder-liquid and paste opaquers with different chemical compositions and viscosity to a metal substructure when they were applied in two thicknesses and to evaluate the failure modes after the bond strength test. METHODS Titanium plates (51 mm x 25 mm x 1mm) (n(plates)=25, N=80, n=10 per group) were conditioned with chairside silica coating (CoJet-Sand, 30 microm silica coated Al(2)O(3)) from a distance of approximately 10mm at a pressure of 2.8 bar for 15 s/cm(2) and silanized. Four types of opaquers, namely one powder-liquid (Sinfony, 3M ESPE), and three paste opaquers [(Cimara, Voco), (Monopaque, Ivoclar Vivadent), (Cavex Experimental, Cavex)] were applied either in 0.25 or 0.50 mm thicknesses using standard polyethylene molds and photo-polymerized. Resin composite (Quadrant Posterior Dense, Cavex) was applied incrementally and photo-polymerized. The specimens were thermocycled (5-55 degrees C, 6000 cycles) prior to shear bond strength test (1mm/min). Failure types were analyzed using an optical microscope and scores were given according to the modified Adhesive Remnant Index (ARI) (Score 0=no opaquer on the surface, Score 1=<1/2 covered with opaquer, Score 2=>1/2 covered with opaquer, Score 3=completely covered with opaquer). RESULTS While thickness did not significantly affect the bond strength results (p=0.523), type of opaquers had a significant influence on the results (p<0.01) (Univariate ANOVA, Tukeys test). Interaction terms between thickness and opaquer type were significant (p<0.01). Debonded specimens during thermocycling were considered as 0 MPa. At both 0.25 and 0.5mm thicknesses, powder-liquid based opaquer (Sinfony) showed significantly higher results (8.4+/-5.6 and 8.4+/-4.9 MPa, respectively) than those of other opaquers (1.4+/-1 to 4.3+/-3.8 MPa) (p<0.05). Only when Cimara was applied in 0.25 mm (6.9+/-4.2 MPa), there were no significant differences with Sinfony (p>0.05). The lowest results in both thicknesses were obtained from Monopaque (4+/-3.8 to 1.6+/-1 MPa, respectively) and Cavex (1.4+/-1 to 4.2+/-2.9 MPa, respectively) paste opaquers. In all opaquers, the incidence of Score 0 (30) was more frequent followed by Score 1 (27) and Score 2 (20). SIGNIFICANCE The use of powder-liquid opaquer in order to mask the metal in repair actions provided higher bond strength than those of the paste opaquers in both thin and thick applications. In all opaquers, the incidence of adhesive failure between the opaquer and the metal was more common implying inadequate adhesion.

Adhesion of resin composite to hydrofluoric acid-exposed enamel and dentin in repair protocols

Intraoral repairs of ceramic fixed-dental-prostheses (FDP) often include cervical recessions that require pretreatment of the exposed tooth surfaces either before or after the ceramic is conditioned with hydrofluoric (HF) acid gel. The sequence of repair protocol may cross-contaminate the exposed etched enamel or dentin surfaces during the application or rinsing process and thereby affect the adhesion. This study evaluated the influence of HF acid gel with two concentrations on bond strengths of composite to enamel and dentin. Human third molars (N=100, n=10 per group) with similar sizes were selected and randomly divided into 10 groups. Flat surfaces of enamel and dentin were created by wet ground finishing. Before or after the enamel (E) or dentin (D) was conditioned with phosphoric acid (P), substrate surfaces were conditioned with either 9.5% HF (HF(9.5)) or 5% HF (HF(5)). Subsequently, a bonding agent (B) was applied. The experimental groups by conditioning sequence were as follows where the first letter of the group abbreviation represents the substrate (E or D) followed by the acid type and concentration: group 1 (EPHF(9.5)), group 2 (EPHF(5)), group 3 (EHF(9.5)P), group 4 (EHF(5)P), group 5 (DPHF(9.5)), group 6 (DPHF(5)), group 7 (DHF(9.5)P), and group 8 (DHF(5)P). Group 9 (EPB) and group 10 (DPB) acted as the control groups. Repair resin was adhered incrementally onto the conditioned enamel and dentin in polyethylene molds. Each layer was photo-polymerized for 40 seconds. All specimens were thermocycled (×1000, 5°-55°C) and subjected to shear test (universal testing machine, 1 mm/min). Specimens that debonded during thermocycling were considered as 0 MPa. The bond strength data were analyzed using Kruskal-Wallis test and failure types using the chi-square test (α=0.05). Overall, the bond results (MPa) were lower on dentin than on enamel (p<0.01). EPB (25.6 ± 6.6) and DPB (20.2 ± 4.9) control groups showed significantly higher results than those of other groups (p<0.05). While higher mean bond strengths were obtained in group 1 (EPHF(9.5)) (11.5 ± 2.1) and group 2 (EPHF(5)) (7.3 ± 0.6), lower results were obtained when HF acid gels were applied prior to phosphoric acid (EHF(9.5)P: 5.0 ± 1.1, EHF(5)P: 3.6 ± 0.1) (p<0.05). On dentin, the results were the lowest in group 8 (DHF(5)P: 1.5 ± 1.6), being significantly lower than those of group 5 (DPHF(9.5)) (p<0.05). Scanning electron microscope (SEM) images revealed predominantly mixed failures with less than half of the composite left on both enamel and dentin surfaces (64 out of 80) (p<0.05), indicating that in general, adhesion was not ideal. Contamination of the enamel or dentin surfaces with HF acid gel impairs the bond strength of composites. Considering both the bond strength results and failure types, when dental tissues are to be repaired next to ceramic, application of phosphoric acid before HF acid gel application can be recommended. HF acid gel concentration did not influence the results except on enamel.

Clinical Study on the Comparison of Masticatory Efficiency and Jaw Movement Before and After Temporomandibular Disorder Treatment

Abstract In this clinical study, pre- and post-rehabilitation changes in intraborder mandible movements, chewing cycles, masticatory efficiencies, and borders of the chewing area of patients with unilateral muscular disorders (MD) (n=20) or unilateral disc derangement disorders (DDD) (n=20) of temporomandibular disorder (TMD) were observed and compared with healthy individuals with full dentition (n=20) (48 female, 12 male; mean age: 28). The MD patients received stabilization splints and the DDD patients, anterior positioning splints for six weeks. Symptoms, such as muscle pain, TMJ pain, headache, chewing difficulty, and maximum mouth opening, showed significant improvements after splint therapy for both MD (p=0.000) and DDD (p=0.000) patients, but lateral excursion and protrusion were not significantly changed (p>0.05). Chewing efficacy and chewing cycles improved significantly (p<0.05) in both the MD (p<0.05) and DDD (p<0.05) groups, but only the MD group was comparable to the control group after treatment. Pre- and post-rehabilitation chewing cycles along the frontal plane on both sides in the MD group were similar to the control group. Considering the majority of the improvements in the diagnostic measures, patients with MD and DDD may benefit from occlusal splint therapy.

Periodontal and trauma splints using fiber reinforced resin composites

Abstract A tooth with mobility as a result of periodontal disease or trauma could be splinted to the intact neighboring teeth using different materials in conjunction with resin composites, and function could be maintained without tooth extraction. This chapter reviews indications, functions, materials, and types of splints and their longevity. Furthermore, some recommendations are provided for clinical applications of direct and indirect fiber-reinforced resin composite (FRC) splints.