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PubMed2005

Micro-shear bond strength and morphological analysis of a self-etching primer adhesive system to fluorosed enamel.

PURPOSE: The aim of this study was to evaluate micro-shear bond strength and morphological analysis of a self-etching primer adhesive system to fluorosed enamel. MATERIALS AND METHODS: Extracted human molars were classified according to the severity of fluorosis using Thylstrup and Fejerskov index into four groups (TFI: 0, normal; 1-3, mild fluorosis; 3-6, moderate fluorosis; 6-7, severe fluorosis) and divided into following two sub-groups. For the first sub-group, a self-etching primer adhesive system was applied to the ground enamel surfaces and the other sub-group was conditioned with 37% phosphoric acid for 30s prior to application of the same adhesive system. Teeth were then restored with a resin composite, stored for 24h in water and micro-shear bond strengths were measured. After shear testing, the fracture modes were observed under a laser scanning microscope. Morphological study of etching patterns and adhesive interface was done under a scanning electron microscope (SEM). The data were analyzed using two-way ANOVA and Sheffe test (p=0.05). RESULTS: No statistically significant difference was there between the different degrees of fluorosis in each sub-group. However, significant difference in the bond strengths between phosphoric acid etching and self-etching was found in moderate and severe groups. The SEM observations showed at the resin-enamel interface, thick resin tag like extensions penetrated around 3.5 microm into the enamel etched with phosphoric acid, while self-etching primer created, 1 microm lamina like penetration. CONCLUSION: Severity of fluorosis affects the micro-shear bond strength of a self-etching bonding system to fluorosed enamel.

Acid Etching, Dental↗
PubMed2006

The physical-mechanical performance of the new Ketac Molar Easymix compared to commercially available glass ionomer restoratives.

OBJECTIVES: To evaluate the time dependence of physical-mechanical performance of glass ionomer restoratives. METHODS: The physical-mechanical properties of Ketac Molar Easymix in comparison to four handmix glass ionomer restoratives were evaluated by testing the compressive and flexural strength, acid erosion and solubility. By testing the properties in the early and late setting phase it was determined how fast the level of material characteristics is achieved. IR spectroscopy was used for monitoring the acid-base reaction. RESULTS: The compressive strength after 1 and 24h setting time show that Ketac Molar Easymix and Fuji IX demonstrate a significantly higher performance. Ketac Molar Easymix exhibits by far the highest flexural strength 1h after start of setting. After 24h, it remains at this high level and only Vitro Molar and Fuji IX come close. Ketac Molar Easymix and Fuji IX show the lowest solubility in neutral media after 24h and 7d. It is remarkable that the solubilities of Ionofil Molar, Vitro Molar and Vidrion R stored in water for 24h are higher than those of Ketac Molar Easymix and Fuji IX obtained after 7d water immersion. In acidic media Ketac Molar Easymix is least prone to acid erosion. CONCLUSIONS: For clinical success of a filling material the early achievement of a high physical-mechanical performance is mandatory to minimize the risk of early damage to a restoration. With the high flexural strength reached after 1h combined with the lowest susceptibility for acid-attack and solubility in water, Ketac Molar Easymix, from 3M ESPE, provides the best performance of any materials tested.

Analysis of Variance↗
PubMed2005

Class II composite resin restorations with two polymerization techniques: relationship between microtensile bond strength and marginal leakage.

OBJECTIVE: To determine the relationship between leakage and microtensile bond strength in the same specimen of direct Class II composite restorations performed with two polymerization techniques. METHODS: Class II slot preparations were made in 40 non-carious human third molars and restored using Single Bond and P-60 (3M ESPE) according to the manufacturer's indications. Half of the preparations had the cervical margin in enamel and half in dentin. Teeth were incrementally restored either with direct polymerization from occlusal surface or with indirect polymerization through translucent matrices and reflective wedges. Teeth were isolated with nail varnish and immersed in fucsin for 24h. Subsequently, they were sectioned into slabs that were measured for leakage (mm), and trimmed to obtain hour-glass shaped specimens for microtensile bond test. Fractured specimens were examined under magnification (40 x) to evaluate the fracture mode. Data were analyzed with Mann-Whitney and Kruskal-Wallis (microleakage), two-way ANOVA and Student-Newman-Keuls tests (bond strength). The relationship between microleakage and microtensile bond strength were analyzed with Spearman's correlation test. RESULTS: There were no significant effects of polymerization technique and margin location on both leakage and bond strength (p>0.05). Bond strengths were higher in preparations with enamel margins than in preparations with dentin margins, when restored with indirect polymerization technique (p<0.05). No significant correlation was found between leakage and bond strength (p>0.05). CONCLUSIONS: Polymerization techniques had no influence on microleakage and bond strength of Class II composite restorations, and there was no relationship between these variables when evaluated in the same specimen.

Analysis of Variance↗
PubMed2005

Evaluation of a reinforced slot design for CEREC system to restore extensively compromised premolars.

OBJECTIVES: The structural stability and adhesive strength of a large-cavity premolar with a CEREC restoration is a frequent problem in long-term use. This study sought to determine whether an additional reinforced slot could increase tooth/ceramic retention using finite element (FE) analysis and fracture testing. METHODS: The cavity was designed in a typical MODL restoration failure shape when the lingual cusp has been lost. Two FE restored-tooth models with different cavity designs were created using image processing, contour stacking, and mesh generation. Interfacial (normal and shear) stresses were then calculated with and without the slot design for restored teeth under lateral and axial forces and different interfacial conditions (bonded and de-bonding). For validation, a fracture experiment was performed with and without reinforced slot designs for large ceramic CEREC restorations. RESULTS: The maximum stresses at the buccal wall increased when a lateral occlusal force acted on the restored tooth with a slot design. Conversely, the interfacial stresses decreased when the restored tooth received a uniform axial occlusal force. After de-bonding on the buccal tooth/ceramic interface, the stresses increased by an average factor of three over those obtained with a bonded interface. The fracture forces were consistent with the tendencies predicted in FE analyses. CONCLUSIONS: An additional reinforced slot for the CEREC restoration of a large cavity could increase retention when a restored tooth receives an axial occlusal load. However, the benefits of a slot seem to be doubtful for a premolar often subjected to a lateral load.

Analysis of Variance↗
PubMed2006

The influence of montmorillonite clay reinforcement on the performance of a glass ionomer restorative.

OBJECTIVES: A pristine calcium montmorillonite (Ca-MMT) and an organically modified 12-amino-dodecanoicacid treated montmorillonite (ADA-MMT) clay were evaluated to determine the reinforcement effect on the performance of a glass ionomer (GI) restorative ChemFil Superior (Dentsply DeTrey, Kanstanz, Germany) to assess the potential as a posterior filling material. METHODS: Mean compressive fracture strengths and standard deviations were determined for groups of 30 cylindrical specimens with 0.5-2.5 wt.% Ca-MMT and ADA-MMT additions to either the powder or the liquid elements of the GI. Working characteristics were assessed using an oscillating rheometer, the interlayer d-spacings (d(001)) of each MMT clay was determined using X-ray diffraction (XRD) and the set cement structure was determined by scanning electron microscopy (SEM). RESULTS: The addition of up to 1.0 wt.% ADA-MMT resulted in a significant increase in the mean compressive fracture strength of the GI utilising the one-way ANOVA and Tukey test comparisons at P<0.05. When Ca-MMT clay was added to the GI a significant reduction in mean strength was recorded (P<0.05). MMT clay addition to the powder and liquid element of the GI in excess of 1.0 wt.% resulted in no significant differences in working characteristics although increases in setting times were evident for MMT addition up to 1.0 wt.%. XRD patterns identified the d(001) peaks for Ca- and ADA-MMT at 2 theta angles of 8.44 degrees and 5.07 degrees and d(001) spacings of 1.04 and 1.74 nm, respectively. CONCLUSIONS: The increased interlayer d-spacings recorded for ADA-MMT clay demonstrates that the clay had expanded layers which may have provided an increased opportunity for the polyacrylic acid chains of the GI restorative to diffuse into the MMT galleries. It is postulated that the increased interlayer d-spacings for the ADA-MMT clay had a positive reinforcing effect on the GI compared with the Ca-MMT clay where no increased performance was identified. The study has highlighted the potential for increasing the performance of GI restoratives when using an organically modified clay as a reinforcement which could increase the potential of GIs as posterior filling materials.

Aluminum Silicates↗
PubMed2004

The efficiency of different light sources to polymerize composite beneath a simulated ceramic restoration.

STATEMENT OF PROBLEM: Inadequate polymerization diminishes the physical properties of composite and compromises material strength. Newly developed light-polymerizing units (plasma arc and high intensity halogen) operate at relatively high intensity and are purported to provide optimum properties to composites in a shorter time. PURPOSE: The aim of this in vitro study was to examine the polymerization efficacy of 3 different polymerization units through a simulated ceramic restoration by determining degree of monomer conversion of a composite luting Material. MATERIAL AND METHODS: A conventional halogen light, a plasma arc light, and a high-intensity halogen light were used to polymerize a composite (Variolink II) with or without catalyst. A pressable ceramic block (5 mm in diameter, 2 mm in height) was used as an interface between the polymerizing light tip and composite. The composite/veneer combination was exposed to 2 different polymerization time protocols for each polymerization unit: (1) 20 or 40 seconds for conventional halogen light, (2) 3 or 6 seconds for plasma arc light, and (3) 10 or 20 seconds (under ramp mode) for the high-intensity halogen light. Using different light units, 120 composite specimens were evaluated (n = 5). Fourier transformation infrared spectroscopy was used to determine the level of light polymerization of the resin through the ceramic material with each of the light sources immediately after polymerization or after 24 hours. Degree of conversion was calculated as a percentage of experimentally polymerized versus maximally polymerized composite. The data were analyzed by 4-factor analysis of variance (alpha = .05). Independent t tests (alpha = .05) were used to detect differences between groups defined by the specific interacting variables. RESULTS: Degree of conversion values varied with the light source (P < .05), polymerization type (P < .05), testing time (P < .01), and exposure to each light source (P < .01). Significant interactions were present between light source and polymerization type (P = .00), light source and testing time (P = .007), and polymerization type and testing time (P = .004). The degree of conversion values were significantly higher in dual-polymerized specimens after 24 hours (P < .01), but there were no significant differences in light-polymerized specimens after 24 hours. The degree of conversion values achieved were significantly lower (P < .05) when specimens were dual polymerized by conventional halogen light and measured immediately (31.59 +/- 7.76). The degree of conversion values achieved were significantly (P < .05) higher with dual polymerization by high-intensity halogen measured after 24 hours (65.06 +/- 8.14). There were no other significant differences among groups. CONCLUSION: The highest degree of conversion values of composite were achieved with polymerization by high-intensity halogen. The plasma arc light achieved similar polymerization of composite through ceramic material in a markedly shorter period than conventional halogen light.

Analysis of Variance↗
PubMed2006

Influence of post-etching cleaning and connecting porcelain on the microtensile bond strength of composite resin to feldspathic porcelain.

STATEMENT OF PROBLEM: There are different methods to fabricate layered feldspathic porcelain restorations, including the refractory die technique and the hot-press technique. Standard adhesive protocol for such restorations requires etching and silanating the fitting surface of the porcelain. Variations in bond strength between porcelain and composite resin might result from the different fabrication methods for porcelain restorations. PURPOSE: The purpose of this study was to determine differences in microtensile bond strength between composite resin (used as a luting agent) and feldspathic porcelain generated from the refractory die technique using 2 different connecting porcelains and the hot-press technique. The effect of post-etching cleaning was also investigated. MATERIAL AND METHODS: Sixteen pairs of ceramic blocks (7 x 8 x 4 mm) were fabricated. Eight pairs were fabricated using feldspathic porcelain (D-B4) on refractory dies. For 4 pairs, the refractory dies were coated with a paste (Ducera Lay Connector Paste; group CON) as a connecting porcelain, and the other 4 pairs were coated with a clear translucent porcelain (CL-O; group CLO). Another 8 block pairs were fabricated using the hot-press technique (Authentic porcelain SL B00+; groups AUTH and AUTH-N). Surface conditioning of the ceramic blocks included airborne-particle abrasion followed by hydrofluoric acid etching (all groups), and post-etching cleaning with a brush/H3PO4 and ultrasonic bath immersion (cleaning not applied to group AUTH-N). All specimens were then silanated/heat dried, and blocks of the same porcelain were bonded to each other using an adhesive resin (Optibond FL) and a light-polymerizing composite resin (Z100). Specimens were stored in water for 24 hours. A nontrimming microtensile bond strength test was applied. Ten beams (0.9 x 0.9 x 8 mm) from each pair of blocks were selected for testing. Bond strength data (MPa) were analyzed with a Kruskal-Wallis test, and post hoc comparison was done using the Mann-Whitney U test (alpha = .05). Additional specimens (1 block per group) were also evaluated for the effect of conditioning steps and mode of fracture using optical microscopy and scanning electron microscopy (SEM) analysis. RESULTS: The mean microtensile bond strengths of CLO and AUTH groups were not significantly different from one another at 46.3 and 49.7 MPa, respectively. For both CON and AUTH-N groups, the mean bond strengths at 37.9 MPa and 24.1 MPa, respectively, were significantly different (P < .05) from the other 3 groups. Optical microscopy revealed a significant amount of white residue for all groups as a result of hydrofluoric etching. Cleaning with a microbrush and 37.5% phosphoric acid for 1 minute resulted in the removal of the crystalline debris. The SEM analysis of specimens cleaned by phosphoric acid brushing alone revealed microscopic deposits still contaminating the etched surface; those were efficiently removed after ultrasonic cleaning. The SEM analysis of fractured beams demonstrated a trend for more mixed-type failure in CON and AUTH-N specimens involving both the composite resin and the surface of the porcelain, whereas CLO and AUTH fractured surfaces were primarily confined to the composite resin. CONCLUSIONS: Increased resin bond strength to refractory-generated porcelain is obtained with CLO as the connecting porcelain compared to the CON paste. The AUTH porcelain exhibited the highest mean bond strength, but omission of post-etching cleaning resulted in the lowest bond strength.

Acid Etching, Dental↗
PubMed2006

An overview of treatment considerations for esthetic restorations: a review of the literature.

Controversy persists regarding the treatment planning criteria for esthetic restorations. This article reviews the literature regarding the biocompatibility, marginal adaptation, color matching, patient selection, technique sensitivity, and mode and rate of failure of tooth-colored restorations. A Medline search was completed for the period from 1986 to 2006, along with a manual search, to identify pertinent English peer-reviewed articles and textbooks. The key words used were amalgam, posterior composite resin, ceramic inlays/onlays, CEREC, porcelain laminate veneers, all-ceramic crowns, and all-ceramic fixed partial dentures.

Acrylic Resins↗
PubMed1991

Examining tooth flexure effects on cervical restorations: a two-year clinical study.

This study evaluated the clinical performance of dentinal adhesives in seven various material/technique combinations. No statistically significant differences were observed among the restorative combinations, or among technique variables after two years in terms of retention, sensitivity or USPHS categories. However, other factors related to tooth flexure--such as occlusal stress, patient age, restorative material and restoration location--showed statistically significant associations with retention failures. These results support a tooth flexural theory of restoration retention.

Acid Etching, Dental↗
PubMed2001

3D-finite element analyses of cusp movements in a human upper premolar, restored with adhesive resin-based composites.

The combination of diverse materials and complex geometry makes stress distribution analysis in teeth very complicated. Simulation in a computerized model might enable a study of the simultaneous interaction of the many variables. A 3D solid model of a human maxillary premolar was prepared and exported into a 3D-finite element model (FEM). Additionally, a generic class II MOD cavity preparation and restoration was simulated in the FEM model by a proper choice of the mesh volumes. A validation procedure of the FEM model was executed based on a comparison of theoretical calculations and experimental data. Different rigidities were assigned to the adhesive system and restorative materials. Two different stress conditions were simulated: (a) stresses arising from the polymerization shrinkage and (b) stresses resulting from shrinkage stress in combination with vertical occlusal loading. Three different cases were analyzed: a sound tooth, a tooth with a class II MOD cavity, adhesively restored with a high (25 GPa) and one with a low (12.5GPa) elastic modulus composite. The cusp movements induced by polymerization stress and (over)-functional occlusal loading were evaluated. While cusp displacement was higher for the more rigid composites due to the pre-stressing from polymerization shrinkage, cusp movements turned out to be lower for the more flexible composites in case the restored tooth which was stressed by the occlusal loading. This preliminary study by 3D FEA on adhesively restored teeth with a class II MOD cavity indicated that Young's modulus values of the restorative materials play an essential role in the success of the restoration. Premature failure due to stresses arising from polymerization shrinkage and occlusal loading can be prevented by proper selection and combination of materials.

Bicuspid↗
PubMed2000

Clinical evaluation of resin-bonded gold alloy veneers.

STATEMENT OF PROBLEM: Clinical performance of resin-bonded alumina-abraded type III cast gold alloy veneers has not been reported. PURPOSE: This retrospective study evaluated the survival of such restorations for the management of tooth wear and other restorative problems. MATERIAL AND METHOD: This clinical study evaluated 25 patients between 14 and 60 years of age treated with a total of 158 cast gold veneers cemented with Panavia Ex cement. Restorations placed between January 1990 and February 1996 (mean age 48 months) were evaluated. Factors, including age, gender, operator, site, design, the extent of dentin exposure, the presence of previous restorations, dynamic and static occlusion, rubber dam, cause, and methods of interocclusal space creation, were evaluated with Cox regression. Survival probability was evaluated with Kaplan-Meier analyses. Significance was taken as P <.05. RESULTS: Failures occurred for 7.6% of restorations in 28% of patients. Alumina-abraded gold alloys cemented with Panavia Ex cement had an estimated 89% survival probability at 60 months using Kaplan-Meier analyses. The only variable to statistically influence survival was operator (P <.0001). Operator differences were due to a single operator who placed only 2 restorations in the same patient, both of which failed unusually quickly. CONCLUSION: Resin-bonded alumina-abraded type III cast gold alloys can be successfully used to restore both anterior and posterior teeth and were associated with an estimated 89% survival probability at 60 months.

Adolescent↗
PubMed1995

Orthodontic and restorative procedures for retained deciduous teeth in the adult.

The restorative dentist will occasionally be confronted with complex treatment planning such as (1) tooth-to-arch dimensional discrepancies, (2) teeth tilted from the vertical midline, (3) teeth overlapped with root contact, (4) horizontal loss of arch dimension from retained deciduous teeth, (5) an impacted adult canine tooth, and (6) peg lateral incisors. Pretreatment diagnostic tooth positioning on replica casts, radiographs, pertinent clinical information, and strategic prosthodontic and orthodontic therapy can ensure predictable treatment. Orthodontic and restorative procedures for three patients with these described discrepancies are detailed to support the direction of treatment planning.

Adult↗
PubMed1989

The addition of an adhesive composite resin to the same material: bond strength and clinical techniques.

The addition of a chemically adhesive composite resin to a restoration of the same material may be evaluated by the bond strength. This was determined after no contamination and after momentary (30 seconds), short-term (7 days), and long-term (3 months) contamination under various conditions. The momentary contamination was not removed by spray-washing the glossy surface that set under a matrix. Removing the glossy surface reduced the bond. The momentary contamination was removed by the etchant whereas the longer contamination was removed only by surface reduction. The application of etchant and bonding agents significantly strengthened the bond to the reduced surface. According to the directives drawn from this investigation, the clinical techniques were illustrated for a large restoration, a subgingival proximal restoration, repair of an open proximal contact, and repair of a worn restoration.

Composite Resins↗
PubMed1996

Assessment of shoulder dimensions and angles of porcelain bonded to metal crown preparations.

The metal ceramic crown is the most popular extracoronal restoration in the United Kingdom. These restorations may fail because of fracture or esthetics. A potential cause of failure is the quality and width of the facial shoulder preparation. In this study 24 extracted human teeth were prepared to receive metal ceramic crowns by one of three dentists. Preparations were replicated and scanned in the midfacial plane by a coordinate measuring machine with a noncontact probe. The x, y, and z surface coordinates were recorded. The results indicated a mean (+/-SD) shoulder width value of 0.752 mm (+/-0.174 mm) and a shoulder angle of 108.54 (+/-15.06) degrees. From these data it would appear that there are deficiencies in shoulder preparations, particularly in width. These inadequacies may have implications for longevity of the restoration and periodontal health in a clinical situation.

Computer Graphics↗
PubMed1996

Stress-induced cervical lesions: review of advances in the past 10 years.

The accumulation of experimental and clinical evidence during the past decade has significantly contributed to the understanding of the role of occlusally generated tensile stress in the etiology of certain noncarious cervical lesions of teeth. More important, this knowledge has led to the understanding of the reasons why traditional restorative treatments of these stress-induced cervical lesions fail. The case of failure can be attributed to the occlusally generated stresses that are concentrated at the cervical region and result in debonding, leakage, retention failure, and, ultimately, restorative failure. With the new understanding, restorative approaches that combine chemical adhesion and restorative materials of appropriate elastic properties show promise of long-term success.

Bite Force↗
PubMed1997

Full veneer versus traditional veneer preparation: a discussion of interproximal extension.

STATEMENT OF PROBLEM: Traditional veneer preparation has come to represent an almost universally accepted guideline of veneer preparation. It calls for an interproximal finish line at or just into the contact point. However, in certain situations, such an approach can have functional and esthetic limitations. PURPOSE: This article reviews those functional and esthetic limitations and discusses an alternative technique, the full veneer preparation. The advantages and disadvantages of this approach are discussed in relation to veneer cases with malaligned teeth, diastema, discoloration, black spaces, restorations, and/or veneers next to crowns.

Crowns↗