The Journal of Adhesive Dentistry, 02/2014

Purpose: To evaluate the radiopacity, ultimate tensile strength (UTS), microhardness (KHN), degree of conversion (DC), water sorption (WS) and solubility (SL) of experimental adhesives. Materials and Methods: Five experimental adhesives with different concentrations of barium-borosilicate oxide microfillers [0% (R0), 30% (R30), 40% (R40), 50% (R50), 60% (R60)] were formulated based on the adhesive system Ambar (FGM). The adhesive Adper Single Bond 2 (SB, 3M ESPE) was used as commercial reference. For the radiopacity (n = 5), KHN (n = 5), WS (n = 10), and SL (n = 10) tests, adhesive disks were constructed (5.0 mm in diameter and 1.0 mm thick), while for UTS (n = 5), hourglass-shaped specimens with a cross-sectional area of 0.8 mm2 were used. The FTIR spectra of unpolymerized and polymerized adhesives were used to determine the DC. Data were submitted to a one-way ANOVA and Tukey's test (α = 0.05). Results: All experimental adhesives showed radiopacity similar to enamel, except those of R0 and SB. Filler addition did not jeopardize the UTS, KHN, or WS of the filled adhesives in comparison with the unfilled version. Except for R40, filler addition reduced the SL. The filled adhesives showed lower DC when compared with R0, but the DC was similar or higher when compared with SB. Conclusions: The addition of barium-borosilicate glass up to 50% did not jeopardize the mechanical properties of the adhesive layer and seems to reduce its solubility Keywords: radiopacity, filler particles, degree of conversion, microhardness, strength, water sorption, solubility

Purpose: This study evaluated the sorption and solubility of self-etching adhesive systems after immersion in distilled water, lactic acid, and propionic acid. Materials and Methods: Specimens of 2 two-step (P90 System Adhesive [P90], Clearfil SE Bond [CSE]) and 1 single-step (Adper Easy One [AEO]) adhesive systems were prepared and divided into 4 groups: P90 primer ( P90-P), P90 bond (P90-B), AEO, and CSE bond (CSE-B). Specimens were placed in a desiccator and weighed daily until achieving a constant mass (m1). The specimens (n = 5) were then immersed in the respective media and weighed until a achieving a constant mass (m2). The specimens were again desiccated (m3). Sorption and solubility data were analyzed with two-way ANOVA and Turkey's test. Specimens were also observed using SEM without immersion, after 24 h, and at the end of the respective total time of immersion. Results: For all immersion media, the highest sorption values were obtained for AEO and P90-P, followed by CSE-B and P90-B, which presented the lowest sorption. The time required for adhesives to absorb the solutions was: 11 to 19 days for P90-P, 12 to 13 days for P90-B, 15 to 19 days for AEO, and 14 to 18 days for CSE-B. The highest values of solubility were shown for AEO and P90-P in all immersion media. In water and propionic acid, the adhesives with the lowest solubility values were CSE-B and P90-B. CSE-B had the lowest solubility in lactic acid. Conclusion: The greatest surface degradation was observed after each respective total time of immersion. AEO specimens presented more evident surface degradation and the highest sorption and solubility. Keywords: sorption, solubility, self-etching adhesives, organic acids, oral biofilm

Purpose: To assess the influence of adhesive restorations on hydrogen peroxide (H2O2) diffusion through enamel and dentin and its cytotoxicity to pulp (MDPC-23) cells. Materials and Methods: Sound and resin-restored enamel/dentin disks were stored in water for 24 h or 6 months and adapted to artificial pulp chambers. Bleaching gels with 20% or 35% H2O2 were applied to the enamel surface for 45 min, and a culture medium in direct contact with the dentin surface (extract) was applied for 1 h to the MDPC-23 cells. Cell metabolism (MTT assay) and cell morphology (SEM) were assessed. The amount of H2O2 in the extracts was also quantified (peroxidase/leuco-crystal violet reaction). Results: A significant reduction in cell metabolism was observed between the group bleached with the 35% gel and the control group (sound, nonbleached) (p 0.05). The H2O2 diffusion was directly related to its concentration in the bleaching gel. The variables "presence of restoration" and "time of water storage" did not significantly influence H2O2 diffusion or cell metabolism for either of the bleaching gels (p > 0.05). All bleached groups presented alterations in cell morphology related to the concentration of H2O2 in the bleaching gel. Conclusion: The reduction in cell metabolism and the changes in cell morphology were H2O2-concentration dependent, having no relationship with the presence of either new or aged adhesive restorations on teeth subjected to bleaching therapies Keywords: odontoblasts, tooth bleaching, cytotoxicity

Purpose: This study measured the effects of using three different exposure times to cure one resin cement through two types of ceramic. Materials and Methods: One light-curing resin cement (Variolink II, Ivoclar Vivadent) was exposed for 20 s, 40 s, or 60 s with a BluePhase G2 light (Ivoclar Vivadent) on the high power setting through 1.0 mm of either ZirPress (ZR) or Empress Esthetic (EST) ceramic (Ivoclar Vivadent). The degree of conversion (DC) of the resin was measured 100 s after light exposure. The Knoop microhardness (KHN) was measured 5 min after light exposure and again after 24 h. The DC and KHN results were analyzed with ANOVA followed by Scheffe's post-hoc multiple comparison tests at α = 0.05. Results: Increasing exposure time had a significant effect on the KHN and DC values for the resins exposed through both ceramics. As exposure times increased, the influence of the ceramic was reduced; however, the microhardness values were greater for the cement exposed through EST ceramic. When the exposure time was increased from 20 s to 40 s, microhardness values for the resin increased by 39.6% through the EST ceramic. When exposed for 60 s, there were no differences between the 100-s DC values or 5-min KHN values using either ceramic (p > 0.05). There was an excellent correlation between the DC at 100 s and the microhardness values measured at 5 min. Conclusion: Resin polymerization was greater through EST than ZR ceramic. At least 40 s to 60 s from the Blue- Phase G2 on high power mode is required to cure this resin cement through 1.0 mm of ceramic. Keywords: leucite-reinforced glass ceramic, fluorapatite glass ceramic, resin-based cement, light curing, resin polymerization, Knoop microhardness, degree of cure

Purpose: To measure the microshear bond strengths (μSBS) of composite resin to the intaglio surface of prefabricated indirect veneers and analyze the FE-SEM ultramorphology of the pretreated intaglio surfaces as well as the fracture modes. Materials and Methods: Three veneer systems (veneer and respective luting material) were used in this study: two prefabricated veneer types, Cerinate One-hour (CER, DenMat) and Componeer (CMP, Coltene), and a laboratory- made veneer, IPS e.max Press (IPS, Ivoclar Vivadent) used as the control. For each group, 10 veneers were used. After delimitation of the bonding area with a double-faced adhesive tape, 0.8-mm-diameter cylinders of composite luting material were bonded to the pretreated intaglio surface. After polymerization, the specimens were fractured in shear mode using the wire-loop method in a universal testing machine. The pretreated intaglio surface of two extra veneers and four fractured specimens per group were morphologically characterized using FE-SEM. Results: CER resulted in statistically lower mean μSBS (7.1 ± 1.2 MPa) than the other two veneer systems, CMP (15.2 ± 2.5 MPa) and IPS (14.7 ± 1.7 MPa) at p 0.0001. As seen with the FE-SEM, the intaglio surface of CMP did not display microretentive features, while multiple microretentions were observed in both CER and IPS after HF etching. Conclusion: Within the limitations of this in vitro study, the CMP and IPS veneer systems resulted in greater bond strengths than those of the CER veneer system. Keywords: dental bonding, ceramic, veneers, composite resin

Purpose: To evaluate the effect of the cementation strategy and mechanical cycling (MC) on the microtensile bond strength (MTBS) of feldspathic inlays cemented to premolars. Materials and Methods: Forty-eight human premolars were prepared and porcelain inlays were produced. Specimens were allocated into 3 groups, based on the cementation strategy: 1) conventional adhesive cementation (RelyX ARC, 3M ESPE): application of etch-and-rinse single bottle adhesive to dentin / ceramic surface treated with hydrofluoric acid (HF) and silane (S) / cementation with resin cement; 2) simplified cementation using a self-adhesive resin cement (RelyX U100, 3M ESPE); 3) modified simplified cementation using a self-adhesive resin cement (RelyX U100, 3M ESPE) with HF+S treatment. Half of the specimens from each group were submitted to MC (2x106 pulses, frequency = 4 Hz, load = 100 N). Each specimen was serially sliced for MTBS and the failures were classified. The stress distribution analysis using FEA was verified. Results: All of the bar-samples from G2 were lost during cutting of the specimens. Mechanical-cycling had no significant effect on bond strength, whereas cementation strategy significant affected MTBS results. The most common type of failure was cohesive of cement. FEA showed that stresses were concentrated mainly at the loading region going up to the root fixation. Conclusion: Porcelain inlays cemented with conventional resin cement or self-adhesive resin cement should be associated with ceramic surface treatment. FEA showed the most critical zone for failure is located in the cement region close to the marginal crest. Keywords: microtensile bond strength, finite element analysis, inlays, mechanical cycling, feldspathic ceramic

Purpose: This study evaluated the effect of either an intermediate application of adhesive resin or flowable resin application on the adhesion of particulate filler composite (PFC) to glass fiber-reinforced composite (FRC). Materials and Methods: Unidirectional, pre-impregnated S2-glass fiber bundles (Dentapreg) (length: 40 mm; thickness: 0.5 mm) were obtained (N = 30, n = 10 per group) and secured in translucent silicone material with the adhesion surface exposed and photopolymerized. They were randomly divided into 3 groups for the following adhesion sequence: A) FRC+PFC, B) FRC+intermediate adhesive resin+PFC, C) FRC+flowable resin+PFC. The PFC was applied in a polyethylene mold onto the FRC and photopolymerized. PFCs were debonded from the FRC surface using shear bond test in a universal testing machine (1 mm/min). After debonding, all specimens were analyzed using scanning electron microscopy to categorize the failure modes. The data were statistically analyzed using one-way ANOVA and Tukey's tests (α = 0.05). Results: A significant difference was observed between the groups (p 0.05). The highest mean bond strength value was obtained with the application of an intermediate layer of adhesive resin (group B: 19.4 ± 1.1 MPa) (p 0.05) followed by group A (14.1 ± 0.6 MPa) and group C (10.4 ± 0.8 MPa), which were also significantly different from one another (p 0.05). Group A exclusively presented a combination of partial cohesive failure in the PFC and adhesive failure between the FRC and PFC. While group B showed large cohesive defects in the FRC, in group C, only small cohesive failures were observed in the FRC. Conclusion: Based on the highest mean bond strength and the large cohesive failures within the FRC, application of an intermediate layer of adhesive resin on the S2-glass FRC surface prior to incremental build up of the PFC seems to be compulsory. Keywords: adhesion, bonding agent, bond strength, dental materials, intermediate adhesive resin, fiber-reinforced composites, flowable resin

Purpose: To evaluate the load-bearing capacities of fiber-reinforced composite (FRC) fixed dental prostheses (FDP) with pontics of various materials and thicknesses. Materials and Methods: Inlay preparations for retaining FDPs were made in a polymer phantom model. Seventytwo FDPs with frameworks made of continuous unidirectional glass fibers (everStick C&B) were fabricated. Three different pontic materials were used: glass ceramics, polymer denture teeth, and composite resin. The FDPs were divided into 3 categories based on the occlusal thicknesses of the pontics (2.5 mm, 3.2 mm, and 4.0 mm). The framework's vertical positioning varied respectively. Each pontic material category contained 3 groups (n = 8/group). In group 1, pontics were fabricated conventionally with composite resin (G-ӕnial, GC) with one additional transversal fiber reinforcement. In group 2, the pontics were polymer denture teeth (Heraeus- Kulzer). Group 3 had an IPS-Empress CAD pontic (Ivoclar Vivadent) milled using a Cerec CAD/CAM unit. Groups 1 and 2 served as controls. Each FDP was statically loaded from the pontic until initial fracture (IF) and final fracture (FF). Initial-fracture data were collected from the load-deflection graph. Results: ANOVA indicated statistically significant differences between the materials and occlusal thicknesses (p 0.001). Quadratic analysis demonstrated the highest correlation between the thickness of the pontic and IF and FF values with ceramic pontics (IF: p 0.001; R2 = 0.880; FF: p 0.001; R2 = 0.953). Conclusion: By increasing the occlusal thickness of the pontic, the load-bearing capacity of the FRC FDPs may be increased. The highest load-bearing capacity was obtained with 4.0 mm thickness in the ceramic pontic. However, with thinner pontics, polymer denture teeth and composite pontics resulted in higher load-bearing values. Keywords: fixed dental prostheses, fiber-reinforced composites, prosthodontics, inlay bridges, CAD/CAM

Purpose: To evaluate the effects of a commercial zirconia primer (Choice or RelyX Unicem) on shear bond strength (SBS) of two different resin composite cements - Choice (a conventional bis-GMA-based resin cement) and RelyX Unicem (self-adhesive resin cement) - to zirconia. Materials and Methods: Zirconia blocks were manufactured and randomly divided into 5 main groups (n = 20) that received surface treatments and cements as follows: no surface treatment, Choice and RelyX Unicem (groups C and U, resp.); tribochemical silica coating followed by silanization, Choice (group SSC); application of a zirconia primer, Choice and RelyX Unicem (groups ZC and ZU, resp.). Light-curing composite resin cylinders were prepared and bonded on the prepared zirconia blocks using the two different resin cements. Half of the specimens in each group were stored in water for 24 h, and half were aged by 50 days of water storage followed by thermocycling (12,000 cycles between 5°C and 55°C). Thereafter, all of them were submitted to the SBS test. Fourier transmission infrared (FT-IR) spectrum analysis and gas mass spectrometry (MS) analysis were adopted for characterization of the zirconia primer. Results: Statistical analysis of the SBS test showed that group C presented the lowest SBS values and group SSC the highest (p 0.01). Artificial aging exerted no influence on the SBS of groups U, SSC, ZC, or ZU. FT-IR analysis suggested that benzene rings and carboxylic groups exist in the zirconia primer. MS analysis detected that 2-hydroxyethyl methacrylate, triethylamine, ethyl-4-dimethylaminobenzoate, ethanol, and water are contained in the primer. Conclusion: The zirconia primer and self-adhesive resin cement increased the SBS of zirconia. Keywords: zirconia, ceramic, bond, adhesion, chemical, primer, surface treatment

Purpose: To evaluate the push-out bond strengths of prefabricated glass-fiber posts (Beijing Oya Biomaterials) with polydopamine functionalized to root dentin using two different resin cements (Paracore and RelyX Unicem) in different root regions (cervical, middle, and apical). Materials and Methods: Forty extracted human, single-rooted teeth were endodontically treated and a 9-mm post space was prepared in each tooth with post drills provided by the manufacturer. Specimens were then randomly assigned into four groups (n = 10 per group), depending on the adhesive system and post surface treatment used: group IA (Paracore + polydopamine); group IB (Paracore + control); group IIA (RelyX Unicem + polydopamine); group IIB (RelyX Unicem + control). Following post cementation, the specimens were stored in distilled water at 37°C for 7 days. The push-out test was performed using a universal testing machine (0.5 mm/ min), and the failure modes were examined with a stereomicroscope. Data were statistically analyzed using twoway ANOVA (p = 0.05). Results: Bond strengths (mean ± SD) were: 7.909 ± 3.166 MPa (group IA), 4.675 ± 2.170 MPa (group IB), 8.186 ± 2.766 MPa (group IIA), 4.723 ± 2.084 MPa (group IIB). The bond strength of polydopamine groups was significantly higher than one of the control groups (p 0.0001). No significant difference was found in the micro push-out bond strengths between the two resin cement groups or the root regions (p > 0.05). Stereomicroscopic analysis showed a higher percentage of adhesive than cohesive failures in all groups. Conclusion: Surface polydopamine functionalization was confirmed to be a reliable method for improving the bond strength of resin luting agents to fiber posts. The bond strength of Paracore to fiber posts was not significantly different from that of RelyX Unicem, and considering its convenient application, Paracore can be recommended. Keywords: glass-fiber posts, polydopamine, push-out bond strength, resin cement, adhesive

Purpose: The aim of this finite element analysis (FEA) study was to test the effect of different restorative techniques on stress distribution in roots with flared canals. Materials and Methods: Five three-dimensional (3D) FEA models that simulated a maxillary incisor with excessive structure loss and flared root canals were created and restored with the following techniques/materials: 1) a prefabricated post: 2) one main and two accessory posts; 3) i-TFC post-core (Sun Medical); 4) the thickness of the root was increased by using composite resin and the root was then restored using a prefabricated post; 5) an anatomic post was created by using composite resin and a prefabricated glass-fiber post. Composite cores and ceramic crowns were created. A 300-N static load was applied at the center of the palatal surface of the tooth to calculate stress distributions. SolidWorks/Cosmosworks structural analysis programs were used for FEA analysis. Results: The analysis of the von Mises and tensile stress values revealed that prefabricated post, accessory post, and i-TFC post systems showed similar stress distributions. They all showed high stress areas at the buccal side of the root (3.67 MPa) and in the cervical region of the root (> 3.67 MPa) as well as low stress accumulation within the post space (0 to 1 MPa). The anatomic post kept the stress within its body and directed less stress towards the remaining tooth structure. Conclusion: The creation of an anatomic post may save the remaining tooth structure in roots with flared canals by reducing the stress levels. Keywords: accessory post, anatomic post, stress distribution, I-TFC post, finite element analysis, endodontic restorations