Richard M. Foxton

Bond Strength of Resin Cements to a Zirconia Ceramic with Different Surface Treatments

This study evaluated the influence of surface treatments and metal primers on the bond strength of resin cements to a yttrium-stabilized tetragonal zirconia (Y-TZP) ceramic. Two-hundred and forty plates of Y-TZP ceramic were randomly assigned to 24 groups (n = 10) according to the combination of surface treatment (none, air abrasion with Al2O3 particles, Er:YAG laser irradiation), metal primer (none, Alloy Primer, Metal Primer II or Metaltite) and resin cement (Calibra [Bis-GMA-based] or Panavia F2.0 [MDP-based]). Fragments of dentin with a cylindrical edge (0.8 mm in diameter) were fixed to ceramic surfaces with the resin cements. The micro-shear bond test was carried out at a 1 mm/minute speed until failure, and the ceramic surfaces were examined after debonding. Bond strengths were analyzed through three-way ANOVA/Tukey test with a 5% significance level. Changes in topography after surface treatments were evaluated with scanning electron microscopy. Surface treatments significantly modified the topography of the Y-TZP ceramic. Air abrasion resulted in increased bond strength for both resin cements. However, air abraded and laser irradiated specimens presented higher bond strength with the Bis-GMA-based resin cement than with the MDP-based cement. Both cements presented similar behavior on untreated surfaces. The three metal primers yielded a significant increase in bond strength, regardless of the surface treatment and resin cement. Adhesive failures were the most prevalent. Air abrasion with Al2O3 particles and the application of metal primers increased bond strength to Y-TZP surfaces for both resin cements.

Effect of primer treatment on bonding of resin cements to zirconia ceramic

OBJECTIVES To evaluate and compare bond strengths of different primers and resin cements to silica-based and zirconia ceramics. METHODS Silica-based and zirconia ceramic specimens were ground flat with #600-grit SiC paper. The ceramic surfaces were airborne-particle abraded and then divided into 11 groups of seven each: untreated (control); and conditioned with one of the six primers in combination with a resin cement from the same manufacturer as follows: Bistite II/Tokuso Ceramic Primer, Linkmax/GC Ceramic Primer, RelyX ARC/RelyX Ceramic Primer, Panavia F 2.0/Clearfil Ceramic Primer, and Resicem/Shofu Porcelain Primer and Resicem/AZ Primer. Stainless steel rods were bonded to the ceramic surfaces using one of the five resin cements. After 24-h water storage, the tensile bond strengths were tested using a universal testing machine and failure modes were examined. RESULTS Conditioning with primers containing a silane coupling agent (all the primers except AZ Primer) significantly enhanced bond strengths of resin cements to silica-based ceramic. For zirconia ceramic, Resicem/AZ Primer exhibited significantly higher bond strength than the other groups except Panavia F 2.0/Clearfil Ceramic Primer. The predominant failure mode of the groups conditioned with primers containing a phosphonic acid monomer (AZ Primer) or a phosphate ester monomer (Clearfil Ceramic Primer and Tokuso Ceramic Primer) was cohesive failure in cements whereas that with the other primers was adhesive failure at the zirconia surfaces. SIGNIFICANCE The use of primers containing a silane coupling agent improved resin bonding to silica-based ceramic. On the other hand, the use of primers containing a phosphonic acid monomer or a phosphate ester monomer improved resin bonding to zirconia ceramic.

Evaluation of the surface roughness and morphologic features of Y-TZP ceramics after different surface treatments.

OBJECTIVE This study aimed to investigate the effect of different energy intensities of the Er:YAG laser and of air abrasion with Al(2)O(3) particles on the surface roughness and morphologic characteristics of yttrium-stabilized tetragonal zirconia (Y-TZP) ceramics. BACKGROUND DATA Surface roughness enhances the micromechanical interlocking of luting agents to ceramic surfaces. However, the most appropriate surface treatment for Y-TZP ceramics has yet to be determined. MATERIALS AND METHODS Two Y-TZP materials were evaluated: Cercon Smart Ceramics and Procera Zirconia. Thirty plates from each ceramic material were randomly divided into five groups according to the surface treatment received (none [control], air abrasion, or irradiation with the Er:YAG laser at three different energy intensities [200, 400, or 600 mJ]). After the surface treatments, the ceramic plates were gold-coated and their surface roughness (Ra, microm) was measured using confocal microscopy. For each ceramic system, the surface roughness was analyzed through two-way ANOVA/Tukeys test, with a 5% significance level. Changes in the morphological characteristics of the ceramics were examined through light and scanning electron microscopy. RESULTS For both zirconia-based materials, irradiation with 400 mJ or 600 mJ increased surface roughness and provided significant morphological changes. Air-abraded Cercon surfaces were rougher compared to the ones irradiated with 200 mJ of laser energy, whereas Procera surfaces irradiated with 200 mJ were rougher than the air-abraded ones. CONCLUSIONS Higher laser power settings (400 and 600 mJ) cause excessive material deterioration, making them unsuitable as surface treatments for zirconia surfaces. Irradiation with 200 mJ provides mild surface alterations, with intermediary features between the effects of air abrasion and higher laser intensities.

Y-TZP Ceramics: Key Concepts for Clinical Application

Compared to conventional ceramic systems, Yttrium-stabilized tetragonal zirconia (Y-TZP) ceramics have some superior mechanical properties, ensuring a broad application in dentistry. The current study aimed to present relevant information about Y-TZP ceramics gathered from peer-reviewed papers. A search of the English language peer-reviewed literature was conducted using the PubMed database between 1998 and 2008. Articles that did not focus exclusively on the clinical application of Y-TZP ceramic restorations were excluded from further evaluation. Selected papers describe the chief characteristics of zirconia ceramics and important clinical features, especially those related to cementation procedures. The literature shows that, although new substances and equipment for the surface preparation of zirconia ceramics are in development, the most promising luting protocol seems to be the use of air abrasion with aluminum oxide particles (silanated or not), followed by the application of resin cements or surface primers containing special reactive monomers. However, because zirconia ceramics have only recently been developed for dental applications, there is not enough clinical evidence to support any definitive cementation protocol.

Long-term evaluation of water sorption and ultimate tensile strength of HEMA-containing/-free one-step self-etch adhesives

OBJECTIVE The objective of this study was to evaluate the water sorption (Wsp) and ultimate tensile strength (UTS) of HEMA-containing/free one-step self-etch adhesives after long-term water-storage. METHODS Three HEMA-containing one-step self-etch adhesives (Bond Force (BF), Clearfil S(3) Bond (S3) and OptiBond All-In-One (OP)), and one HEMA-free one-step self-etch adhesive, G Bond (GB) was used. After the solvents of each adhesive were evaporated, polymerised adhesive disks and dumbbell-shaped specimens of thirty-two each were prepared and divided into four groups of 14-, 90-, 180- and 360-day water-storage. After immersion in water for the designated storage periods, the disks were subjected to measurement of Wsp, and the dumbbell-shaped specimens were subjected to measurement of UTS. The data of Wsp and UTS were statistically analysed using a two-way ANOVA and Bonferroni test. RESULTS Wsp of BF, S3 and OP increased over time, whereas for GB, there were no significant differences in Wsp among all the storage periods. Wsp of GB was lower than those of BF, S3 and OP in each period. The UTS of BF, S3 and OP decreased over time, whereas for GB, there were no significant differences in UTS among all storage periods. The highest UTS was initially seen in BF>GB=S3=OP, and after 360-day water-storage, seen in BF=GB>OP=S3. CONCLUSIONS For the HEMA-containing adhesives, Wsp increased and UTS decreased over time. On the other hand, for the HEMA-free adhesive, Wsp and UTS did not significantly change even after 360-day water-storage.

Durability of Resin Cement Bond to Aluminium Oxide and Zirconia Ceramics after Air Abrasion and Laser Treatment

PURPOSE The erbium laser has been introduced for cutting enamel and dentin and may have an application in the surface modification of high-strength aluminum oxide and zirconia ceramics. The aim of this study was to evaluate the durability of the bond of conventional dual-cured resin cements to Procera Al(2)O(3) and zirconium oxide ceramics after surface treatment with air abrasion and erbium laser. MATERIALS AND METHODS One hundred twenty Al(2)O(3) and 120 zirconia specimens measuring 3 × 3 × 0.7 mm(3) were divided equally into three groups, and their surfaces treated as follows: either untreated (controls), air abraded with Al(2)O(3) particles, or erbium-laser-treated at a power setting of 200 mJ. The surface of each specimen was then primed and bonded with one of two dual-cured resin cements (either SCP-100 Ceramic Primer and NAC-100 or Monobond S and Variolink II) using a 1-mm thick Tygon tube mold with a 0.75-mm internal bore diameter. After 24 hours and 6 months of water storage at 37°C, a microshear bond strength test was performed at a crosshead speed of 1 mm/min. Surface morphology was examined using a confocal microscope, and failure modes were observed using an optical microscope. The data were analyzed using the Kaplan-Meier nonparametric survival analysis. RESULTS In the case of zirconia, air abrasion and Erbium:yttrium-aluminum-garnet (Er:YAG) laser treatment of the ceramic surface resulted in a significant reduction in the bond strengths of both resin cements after 6 months water storage; however, when the zirconia surface was left untreated, the SCP-100/NAC-100 group did not significantly reduce in bond strength. In the case of alumina, no treatment, air abrasion and Er:YAG laser treatment of the surface led to no significant reduction in the bond strengths of the three SCP-100/NAC-100 groups after 6 months water storage, whereas all three Monobond S/Variolink II groups showed a significant reduction. CONCLUSION Er:YAG laser treatment of the zirconia surface did not result in a durable resin cement/ceramic bond; however, a durable bond between a conventional dual-cured resin cement and Procera All Ceram and Procera All Zirkon was formed using a ceramic primer containing the phosphate monomer, MDP, without any additional surface treatment.

Translucency, opalescence and light transmission characteristics of light-cured resin composites.

OBJECTIVES To evaluate the translucency, opalescence and light transmission characteristics of resin composites with different thicknesses. METHODS Disks of three resin composites (Estelite∑, Beautifil II, Clearfil Majesty) of A2 shade were prepared in diameter of 10mm with various thicknesses (0.5mm, 1.0mm and 2.0mm). Color was measured according to CIELAB color scale on a reflection spectrophotometer and a color haze meter, and translucency parameter (TP) and opalescence parameter (OP) were calculated. Using the distribution graphs of transmitted light intensity on a goniophotometer, diffusion factor (DF) as an indicator for a diffuse transmission property and peak gain (G0) for a straight-line transmission property were calculated. RESULTS The TP and G0 values significantly decreased in the order: 0.5mm>1.0mm>2.0mm thickness (p<0.05). The OP value increased as the thickness of resin composite increased from 1.0mm to 2.0mm (p<0.05), while was similar for the 0.5mm- and 1.0mm-thick groups. The DF value increased from 0.5mm to 1.0mm, but was similar for the 1.0mm- and 2.0mm-thick groups. There was a significant correlation between TP and DF (R(2)=0.96, p<0.001). On the other hand, there was a weak correlation between OP and DF (R(2)=0.21, p<0.005), however within the values of the 0.5mm-thick group, OP was highly correlated with DF (R(2)=0.84, p<0.001). SIGNIFICANCE At the 0.5mm thickness, the translucency (TP) and opalescence (OP) of resin composites had a significant correlation with a diffuse transmission property (DF). When more than 1.0mm thickness of resin composites, translucency and opalescence were influenced by the thickness, in which translucency significantly decreased and opalescence significantly increased.

Bioactive effects of a calcium/sodium phosphosilicate on the resin–dentine interface: a microtensile bond strength, scanning electron microscopy, and confocal microscopy study

This study evaluated, through microtensile bond strength (μTBS) testing, the bioactive effects of a calcium/sodium phosphosilicate (BAG) at the resin-dentine interface after 6 months of storage in phosphate buffer solution (PBS). Confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM) were also performed. Three bonding protocols were evaluated: (i) RES-Ctr (no use of BAG), (ii) BAG containing adhesive (BAG-AD), and (iii) BAG/H (3) PO (4) before adhesive (BAG-PR). The dentin-bonded specimens were prepared for μTBS testing, which was carried out after 24 h or 6 months of storage in PBS. Scanning electron microscopy ultramorphology analysis was performed after debonding. Confocal laser scanning microscopy was used to evaluate the morphological and nanoleakage changes induced by PBS storage. High μTBS values were achieved in all groups after 24 h of storage in PBS. Subsequent to 6 months of storage in PBS the specimens created using the BAG-AD bonding approach still showed no significant reduction in μTBS. Moreover, specimens created using the BAG-AD or the BAG-PR approach showed an evident reduction of nanoleakage after prolonged storage in PBS. The use of BAG-containing adhesive may enhance the durability of the resin-dentine bonds through therapeutic/protective effects associated with mineral deposition within the bonding interface and a possible interference with collagenolytic enzyme activity (matrix metalloproteinases) responsible for the degradation of the hybrid layer.

Experimental etch-and-rinse adhesives doped with bioactive calcium silicate-based micro-fillers to generate therapeutic resin–dentin interfaces

OBJECTIVES This study aimed at evaluating the therapeutic bioactive effects on the bond strength of three experimental bonding agents containing modified Portland cement-based micro-fillers applied to acid-etched dentin and submitted to aging in simulated body fluid solution (SBS). Confocal laser (CLSM) and scanning electron microscopy (SEM) were also performed. METHODS A type-I ordinary Portland cement was tailored using different compounds such as sodium-calcium-aluminum-magnesium silicate hydroxide (HOPC), aluminum-magnesium-carbonate hydroxide hydrates (HCPMM) and titanium oxide (HPCTO) to create three bioactive micro-fillers. A resin blend mainly constituted by Bis-GMA, PMDM and HEMA was used as control (RES-Ctr) or mixed with each micro-filler to create three experimental bonding agents: (i) Res-HOPC, (ii) Res-HCPMM and (iii) Res-HPCTO. The bonding agents were applied onto 37% H3PO4-etched dentin and light-cured for 30s. After build-ups, they were prepared for micro-tensile bond strength (μTBS) and tested after 24h or 6 months of SBS storage. SEM analysis was performed after de-bonding, while CLSM was used to evaluate the ultra-morphology/nanoleakage and the mineral deposition at the resin-dentin interface. RESULTS High μTBS values were achieved in all groups after 24h. Only Res-HOPC and Res-HCPMM showed stable μTBS after SBS storage (6 months). All the resin-dentin interfaces created using the bonding agents containing the bioactive micro-fillers tested in this study showed an evident reduction of nanoleakage and mineral deposition after SBS storage. CONCLUSION Resin bonding systems containing specifically tailored Portland cement micro-fillers may promote a therapeutic mineral deposition within the hybrid layer and increase the durability of the resin-dentin bond.

Bond strength and ultimate tensile strength of resin composite filled into dentine cavity; effect of bulk and incremental filling technique

OBJECTIVES The aim of this study was to evaluate the relationship between micro-tensile bond strength (muTBS) and ultimate tensile strength (UTS) of resin composite restorations in cavities filled by a bulk or incremental technique using the micro-tensile test. METHODS Class I cavities (4mm long, 3mm wide, 3mm deep) were prepared into dentine of sixteen human molars. All cavities were bonded with Clearfil SE Bond and restored with AP-X composite with either a bulk or incremental technique. After storage in water for 24h, the teeth were vertically sectioned to yield two slabs. Each slab was sectioned into three sticks. Sticks of one slab were trimmed into an hourglass of 0.7 mm2 area at resin-dentine interface for bond strength measurement while the other sticks were trimmed at the centre of the restoration for UTS measurement. Specimens were tested in tension at 1mm/min until failure. The results obtained were statistically analysed using two-way ANOVA and post hoc test (alpha=0.05). Pearsons correlation test was used to identify any correlation between muTBS and UTS for each filling method. RESULTS Both muTBS and UTS of resin composite decreased towards the bottom of the cavity (p<0.05). The bulk technique group presented lower muTBS than the incremental technique groups at all regions (p<0.05). In bulk filled restoration, there was a strong positive linear relationship between mean values of muTBS and UTS of resin composite based on the depth (r2=.99; p<0.05), while in incremental restoration there was no relationship between the variables. CONCLUSIONS There was a relationship between muTBS and UTS of resin composite filled into dentin cavity in bulk technique.