Sarah Pollington

The effect of different surface treatments on bond strength between leucite reinforced feldspathic ceramic and composite resin.

OBJECTIVES The aim of this study was to evaluate the effect of different surface treatments on the microtensile bond strength between a leucite reinforced glass-ceramic and composite resin. METHODS Leucite reinforced ceramic blocks (n=24) were constructed using the hot pressing technique. The blocks were assigned to 4 groups, which received the following surface treatments: G1: hydrofluoric (HF) acid and silane; G2: silane alone; G3: HF acid and silane then dried with warm air (100 degrees C); G4: silane alone then dried with warm air (100 degrees C). Unfilled resin was applied, followed by composite resin. Specimens were prepared and loaded in tension to determine the microtensile bond strength. Failure modes were classified by stereo- and scanning electron microscopy (SEM). Data was analysed using Kruskal-Wallis test followed by the Dunns multiple range test. RESULTS The groups including the warm air step (G3 and G4) achieved a significantly stronger adhesion than G1 and G2. Pre-treatment of the surface with hydrofluoric acid in G1 resulted in significantly higher bond strength than G2. Failures were mostly cohesive in the luting resin for G1, G3 and G4 and mainly adhesive at the ceramic-resin interface in G2. CONCLUSIONS The method of application of silane to the ceramic surface can have a significant influence on the adhesion between the ceramic restoration and the resin cement. Enhancing the condensation reaction by drying the silane with a 100C warm air stream significantly improved the microtensile bond strength, possibly eliminating the need for the hydrofluoric acid etching step.

Microleakage in class II restorations: open vs closed centripetal build-up technique.

PURPOSE This study evaluated whether a Class II restoration in a flowable resin composite has to be placed prior to (open-sandwich technique) or after (closed-sandwich technique) construction of the interproximal wall in the centripetal build-up technique in order to reduce microleakage. METHODS AND MATERIALS Thirty non-carious molars were selected and randomly divided into two groups (n = 15). A standardized Class H preparation was made with the cervical margin 1 mm below the cementum-enamel junction. In Group 1, flowable resin composite was applied as a 1 mm base, remaining exposed at the cervical margin. In Group 2, the hybrid resin composite was applied to the interproximal wall, followed by a layer of flowable composite on the pulpal floor, away from the margins. The restorations were then subjected to 500 thermal cycles, each with a dwell time of 20 seconds at 5 degrees C and 55 degrees C. Adaptation at the cervical margin was evaluated by dye penetration and SEM analysis using the replica technique. The data were statistically analyzed using the Mann-Whitney U-test (p < 0.05). RESULTS The centripetal open-sandwich technique led to significantly lower dye penetration than the centripetal closed-sandwich technique (p < 0.001). CONCLUSION Flowable resin composite placed under hybrid resin composites in Group 1 provided better marginal adaptation and fewer voids. However, neither Group 1 nor Group 2 was able to completely prevent microleakage.

Microtensile bond strength of a resin cement to a novel fluorcanasite glass-ceramic following different surface treatments

OBJECTIVES This study evaluated the effect of surface treatments on the bond strength of fluorcanasite and lithium disilicate glass-ceramics, with the possibility of eliminating HF etching of these ceramics. METHODS Fifteen blocks of an experimental fluorcanasite and a lithium disilicate glass-ceramic (IPS e.max CAD) were assigned to one of the following three surface treatments: (1) machined with 60 microm finish, (2) machined and grit blasted, (3) machined and HF etched. The ceramic blocks were duplicated in composite resin (Spectrum) and cemented together with a resin luting agent (Variolink II). Thirty microbars per group (1.0 x 1.0 x 20 mm) were obtained and subjected to a tensile force at a crosshead speed of 0.5 mm/min using a universal testing machine until failure. The mode of failure was determined using scanning electron microscopy. The appropriate bonding procedure was assessed for durability by storing in water at 100 degrees C for 24 h. Statistical analyses were performed with ANOVA and Tukeys test (P<0.05). RESULTS Machining alone significantly increased the bond strength (MPa) of the fluorcanasite (27.79+/-6.94) compared to the lithium disilicate (13.57+/-4.52) (P<0.05). HF etching resulted in the lowest bond strength (8.79+/-2.06) for the fluorcanasite but the highest for the lithium disilicate (24.76+/-9.38). Regarding durability, the machined fluorcanasite (15.24+/-5.46) demonstrated significantly higher bond strength than the machined and HF etched lithium disilicate (12.28+/-3.30). SIGNIFICANCE The fitting surface of the fluorcanasite glass-ceramic should retain the machined finish and be directly treated with silane. The use of HF acid is contraindicated.

Efficacy of two alcohol-free cetylpyridinium chloride mouthwashes - a randomized double-blind crossover study.

AIM (1) To determine the plaque inhibition properties of two formulations of alcohol-free mouthwash [0.1% w/w cetylpyridinium chloride (CPC) (B) and 0.05% w/w CPC (A)] versus a placebo mouthwash (C). (2) To compare the plaque-inhibiting activity between these two new CPC mouthwashes. MATERIAL AND METHODS A double-blind, crossover study with three 1-week periods was used. Subjects were randomly assigned to one of the following groups. Group 1 (n=10) received the mouthwashes A, C and B in the periods 1, 2 and 3, respectively, group 2 (n=11) received the mouthwashes in the order B, A, C, while group 3 (n=11) received the mouthwashes in the order C, B, A. Mean plaque areas and Quigley & Hein plaque index scores were analysed using anova (analysis of variance). Measurements were made at the start of each period (baseline) and at 16, 24 and 40 h. RESULTS Mean plaque scores were similar across the groups at baseline. At all time points thereafter, volunteers using mouthwash A or B had significantly lower plaque areas and plaque index scores than those using mouthwash C (p<0.05), but there were no significant differences between the test formulations. At 16 h, the reduction in plaque area relative to mouthwash C was 22% for mouthwash A and 18% for mouthwash B; at 24 h, 11% for mouthwash A and 15% for mouthwash B; and at 40 h, 15% for mouthwash A and 16% for mouthwash B. CONCLUSIONS The use of both CPC mouthwashes resulted in less plaque accumulation compared with the control. There was no statistically significant difference in plaque accumulation between the two CPC mouthwashes.

Fracture strength of minimally prepared all-ceramic CEREC crowns after simulating 5 years of service

OBJECTIVES To examine the strength and mode of fracture of traditionally and minimally prepared all-ceramic resin bonded CAD/CAM crowns after fatigue loading. METHODS Thirty human maxillary molars were used and divided in three groups namely; traditional crown preparation group (I), minimal crown preparation group (II) and occlusal veneer preparation group (III). A leucite reinforced glass ceramic (IPS Empress CAD) was used for fabricating the crowns. The CEREC InEOS system (v3.10) was used for scanning, designing and milling. Five years of clinical service were simulated and the fracture strength of the crowns was measured. One-way ANOVA and Kruskal-Wallis test were used for data analysis (α=0.05). RESULTS The mean fracture strength and SD in Group I was 1070N (±181) and in Group II 1110N (±222). One-way ANOVA analysis showed no statistically significant difference between the two groups (p>0.05). In Group III all restorations developed cracks during TCML and were not subjected to fracture loading. Three of the traditionally designed crowns (Group I) and 4 of the minimally designed crowns (Group II) developed surface cracks during TCML. SIGNIFICANCE Minimal all-ceramic resin-bonded crowns can potentially form a viable restorative option as they demonstrated comparable strength to traditional all-ceramic crowns. However, this should be interpreted with caution as a number of crowns showed cracks after 5 years of simulated service. All the occlusal veneers developed cracks during simulation and further investigation is needed for this to be considered a viable option.

Manufacture, characterisation and properties of novel fluorcanasite glass-ceramics.

OBJECTIVE The aim of this study was to investigate the manufacture and characterisation of different compositions of fluorcanasite glass-ceramics with reduced fluorine content and to assess their mechanical and physical properties. METHODS Three compositional variations (S80, S81 and S82) of a fluorcanasite glass were investigated. Differential thermal analysis (DTA) and X-ray diffraction (XRD) identified crystallisation temperatures and phases. X-ray fluorescence (XRF) determined the element composition in the glass-ceramics. Different heat treatments [2 h nucleation and either 2 or 4 h crystallisation] were used for the glasses. Scanning electron microscopy (SEM) examined the microstructure of the cerammed glass. The chemical solubility, biaxial flexural strength, fracture toughness, hardness and brittleness index of S81 and S82 fluorcanasite were investigated with lithium disilicate (e.max CAD, Ivoclar Vivadent) as a commercial comparison. Statistical analysis was performed using one-way ANOVA with Tukeys multiple comparison tests (P<0.05). Weibull analysis was employed to examine the reliability of the strength data. RESULTS All compositions successfully produced glasses. XRD analysis confirmed fluorcanasite formation with the S81 and S82 compositions, with the S82 (2+2h) showing the most prominent crystal structure. The chemical solubility of the glass-ceramics was significantly different, varying from 2565 ± 507 μg/cm(2) for the S81 (2+2 h) to 722 ± 177 μg/cm(2) for the S82 (2+2 h) to 37.4 ± 25.2 μg/cm(2) for the lithium disilicate. BFS values were highest for the S82 (2+2 h) composition (250 ± 26 MPa) and lithium disilicate (266 ± 37 MPa) glass-ceramics. The fracture toughness was higher for the S82 compositions, with the S82 (2+2h) attaining the highest value of 4.2 ± 0.3 MPa m(1/2)(P=0.01). The S82 (2+2 h) fluorcanasite glass-ceramic had the lowest brittleness index. CONCLUSION The S82 (2+2 h) fluorcanasite glass-ceramic has acceptable chemical solubility, high biaxial flexural strength, fracture toughness and hardness. CLINICAL SIGNIFICANCE A novel glass-ceramic has been developed with potential as a restorative material. The S82 (2+2 h) has mechanical and physical properties that would allow the glass-ceramic to be used as a machinable core material for veneered resin-bonded ceramic restorations.

Evaluation of a novel multiple phase veneering ceramic.

OBJECTIVES To produce a new veneering ceramic based on the production of a multiple phase glass-ceramic with improved performance in terms of strength and toughness. METHODS A composition of 60% leucite, 20% diopside and 20% feldspathic glass was prepared, blended and a heat treatment schedule of 930°C for 5 min was derived from differential thermal analysis (DTA) of the glasses. X-ray diffraction (XRD) and SEM analysis determined the crystalline phases and microstructure. Chemical solubility, biaxial flexural strength (BFS), fracture toughness, hardness, total transmittance and coefficient of thermal expansion (CTE) were all measured in comparison to a commercial veneering ceramic (VITA VM9). Thermal shock resistance of the leucite-diopside and VITA VM9 veneered onto a commercial high strength zirconia (Vita In-Ceram YZ) was also assessed. Statistical analysis was undertaken using Independent Samples t-test. Weibull analysis was employed to examine the reliability of the strength data. RESULTS The mean chemical solubility was 6 μg/cm(2) for both ceramics (P=1.00). The mean BFS was 109 ± 8 MPa for leucite-diopside ceramic and 79 ± 11 MPa for VITA VM9 ceramic (P=0.01). Similarly, the leucite-diopside ceramic demonstrated a significantly higher fracture toughness and hardness. The average total transmittance was 46.3% for leucite-diopside ceramic and 39.8% for VITA VM9 (P=0.01). The leucite-diopside outperformed the VITA VM9 in terms of thermal shock resistance. Significance This novel veneering ceramic exhibits significant improvements in terms of mechanical properties, yet retains a high translucency and is the most appropriate choice as a veneering ceramic for a zirconia base core material.

The Influence of Plastic Light Cure Sheaths on the Hardness of Resin Composite

OBJECTIVE This study investigated the influence of a disposable light cure sheath on both the surface hardness and hardness at varying thicknesses of resin composite. METHODS A series of resin composite discs (Spectrum) were fabricated with varying depths up to 6 mm. The light curing units used were a standard halogen unit (Elipar Trilight) and an LED unit (Elipar Freelight 2). Recommended curing times from the manufacturer were followed. The disposable light-curing sheath (Cure Sleeve) was used with both light-curing units. Two additional groups without the sheath were employed as controls. Each specimen (n = 4) was subjected to hardness testing to evaluate hardness from 0 mm to 5 mm thick. A 200g load was applied for 10 seconds using a Vickers diamond indenter and six indentations were obtained from each specimen. Statistical analysis was performed using two-way ANOVA. RESULTS The LED without a sheath achieved the highest surface hardness value (47.2 VHN +/- 5.5). There was no significant difference between the groups regarding surface hardness (p > 0.05). As the thicknesses of the resin composite increased, the hardness values decreased in all groups. The LED light curing unit, in combination with a sheath, demonstrated the lowest hardness values at a 5 mm thickness of resin composite (p < 0.05). CONCLUSION All four different methods of light curing resulted in a significant reduction in hardness values with increasing resin composite thickness, which could compromise the mechanical properties of the resin composite. However, the use of the light cure sheaths still provided an acceptable depth of cure when used following the 2 mm increment rule. It was not until 3 mm that the use of the light cure sheaths compromised the hardness results. It is recommended that the curing depth should not exceed 2 mm, regardless of light curing method.

Comparative in vitro evaluation of CAD/CAM vs conventional provisional crowns

ABSTRACT Objective This study compared the marginal gap, internal fit, fracture strength, and mode of fracture of CAD/CAM provisional crowns with that of direct provisional crowns. Material and Methods An upper right first premolar phantom tooth was prepared for full ceramic crown following tooth preparation guidelines. The materials tested were: VITA CAD-Temp®, Polyetheretherketone “PEEK”, Telio CAD-Temp, and Protemp™4 (control group). The crowns were divided into four groups (n=10), Group1: VITA CAD-Temp®, Group 2: PEEK, Group 3: Telio CAD-Temp, and Group 4: Protemp™4. Each crown was investigated for marginal and internal fit, fracture strength, and mode of fracture. Statistical analysis was performed using GraphPad Prism software version 6.0. Results The average marginal gap was: VITA CAD-Temp® 60.61 (±9.99) µm, PEEK 46.75 (±8.26) µm, Telio CAD-Temp 56.10 (±5.65) µm, and Protemp™4 193.07(±35.96) µm (P<0.001). The average internal fit was: VITA CAD-Temp® 124.94 (±22.96) µm, PEEK 113.14 (±23.55) µm, Telio CAD-Temp 110.95 (±11.64) µm, and Protemp™4 143.48(±26.74) µm. The average fracture strength was: VITA CAD-Temp® 361.01 (±21.61) N, PEEK 802.23 (±111.29) N, Telio CAD-Temp 719.24 (±95.17) N, and Protemp™4 416.40 (±69.14) N. One-way ANOVA test showed a statistically significant difference for marginal gap, internal gap, and fracture strength between all groups (p<0.001). However, the mode of fracture showed no differences between the groups (p>0.05). Conclusions CAD/CAM fabricated provisional crowns demonstrated superior fit and better strength than direct provisional crowns.

Fracture resistance of zirconia-composite veneered crowns in comparison with zirconia-porcelain crowns

The objectives were to evaluate the fracture resistance and stress concentration in zirconia/composite veneered crowns in comparison to zirconia/porcelain crowns using occlusal fracture resistance and by stress analysis using finite element analysis method. Zirconia substructures were divided into two groups based on the veneering material. A static load was applied occlusally using a ball indenter and the load to fracture was recorded in Newtons (N). The same crown design was used to create 3D crown models and evaluated using FEA. The zirconia/composite crowns subjected to static occlusal load showed comparable results to the zirconia/porcelain crowns. Zirconia/composite crowns showed higher stress on the zirconia substructure at 63.6 and 50.9 MPa on the zirconia substructure veneered with porcelain. In conclusion, zirconia/composite crowns withstood high occlusal loads similar to zirconia/porcelain crowns with no significant difference. However, the zirconia/composite crowns showed higher stress values than the zirconia/porcelain crowns at the zirconia substructure.