Clinical application and prospects of zirconia bonding agent / 中国组织工程研究

BACKGROUND: Zirconia ceramic was considered as one of the optimal materials in prosthodontics and widely used in daily clinical treatment for its features, such as aesthetic properties, biocompatibility and corrosion resistance. Ideal bond strength and durability are necessary for the restoration to achieve satisfied clinical performance. OBJECTIVE: To systematically review zirconia and common zirconia bonding agents, the physical and chemical properties of zirconia ceramics, the clinical operating process standard, the common zirconia bonding agents and their bonding performance. METHODS: We searched the articles from March 2005 to March 2020 in PubMed, CNKI, Wanfang databases with the key words of “zirconia; surface treatment; universal adhesive; self-adhesive resin cement; bonding strength” in Chinese and English. After screening according to inclusion and exclusion criteria, the final 36 included articles were summarized. RESULTS AND CONCLUSION: Zirconia has excellent physical and chemical properties with hydrophobic surface, so it is difficult to form a proper bonding surface with the substrate. At present, the combination of physical sand blasting and chemical reaction is the most common treatment. The sand blasting can effectively increase the reaction area. In the aspect of chemical bonding, the bond strength of the self-adhesive resin cement can be significantly improved by both the universal adhesive and zirconia primer after 24 hours of water storage; however, the durability of universal adhesive is better than that of zirconia primer. As common sense, 37% phosphoric acid is daily used on tooth surface before bonding procedure, which can prohibit chemical reaction to zirconia. Sand blasting was considered as one of the most practical way to physically increase the surface for 10-MDP contained primers or universal adhesives chemically reacted with zirconia.

Effects of universal adhesives and resin cement on the shear bond strength of zirconia / 华西口腔医学杂志

OBJECTIVE@#To study the effects of universal adhesives and resin cement on the shear bond strength and durability of zirconia ceramics.@*METHODS@#Zirconia ceramics were sintered into 20 mm×10 mm×10 mm and 10 mm×10 mm×10 mm specimens. The experiment was divided into 12 groups. The two types of specimens were bonded using two variants of resin cement (RelyX Ultimate and Clearfil SAC self-adhesive resin cement), universal adhesives (non-adhesive, Scotchbond uni-versal adhesive, and Clearfil SE One adhesive), and storage conditions (water bath and water bath-thermal cycling). The shear bond strengths were tested, and the fracture morphologies were analyzed.@*RESULTS@#The cement (F=8.41, P<0.01) and adhesive (F=30.34, P<0.01) exerted a significant effect on the shear bond strength of zirconia, whereas storage condition showed no significant effect on this property (F=1.83, P=0.18). The lowest shear bond strength (14.02 MPa±6.86 MPa) was exhibited by the group treated with RelyX Ultimate resin cement, non-adhesive, and water bath-thermal cycling, whereas the highest shear bond strength (54.12 MPa±8.37 MPa) was displayed by the group treated with RelyX Ultimate resin cement, Scotchbond universal adhesive, and water bath-thermal cycling.@*CONCLUSIONS@#Universal adhesives can improve the durability of the bonding of resin cement to zirconia. If non-self-adhesive resin cement is used without a universal adhe-sive, the durability of the bond will be greatly reduced.

Effect of post-space irrigation with naocl and caocl at different concentrations on the bond strength of posts cemented with a self-adhesive resin cement

Abstract The aim of this study was to evaluate the effect of post-space irrigation with NaOCl and CaOCl at different concentrations on the bond strength of posts cemented with a self-adhesive resin cement. Eighty premolars were sectioned 14 mm from the apex, and endodontically treated. The root canal filling was partially removed. Specimens were randomly assigned into 8 groups (n=10), according to the irrigant for post-space irrigation: SS - 0.9% saline solution (control group); CHX - 2% chlorhexidine; 1% NaOCl - 1% sodium hypochlorite; 2.5% NaOCl - 2.5% sodium hypochlorite; 5% NaOCl - 5% sodium hypochlorite; 1% CaOCl - 1% calcium hypochlorite; 2.5% CaOCl - 2.5% calcium hypochlorite; and 5% CaOCl - 5% calcium hypochlorite. For each group, irrigation was performed continuously with 2 ml of solution. The post-spaces were dried with paper points (#80), and glass fiber posts were cemented using a self-adhesive resin cement. The specimens were sectioned perpendicularly and the push-out test was performed. Optical microscopy was used to analyze the failure mode. ANOVA and Bonferroni tests analyzed the bond strength data. NaOCl and CaOCl presented similar bond strength regardless the concentration used to irrigate the post-space (p>0.05). SS showed the highest bond strength (11.47 MPa) (p<0.05). Adhesive failures at the cement/dentin interface were predominant (58.33%). Saline solution should be irrigant of choice to irrigate the post-space before fiber post cementation with self-adhesive resin cement. NaOCl and CaOCl negatively affect the bond strength values.

Resumo O objetivo deste estudo foi avaliar o efeito da irrigação do espaço preparado para o pino com NaOCl e CaOCl em diferentes concentrações na resistência adesiva de pinos cimentados com um cimento resinoso autoadesivo. Oitenta pré-molares foram seccionados 14 mm do ápice e endodonticamente tratado. As obturações foram parcialmente removidas. Os espécimes divididos randomicamente em 8 grupos (n=10) de acordo com o irrigante usado para irrigação do espaço preparado para pino: SF - soro fisiológico 0,9% (grupo controle); CHX - clorexidina 2%; NaOCl 1% - hipoclorito de sódio 1%; NaOCl 2,5% - hipoclorito de sódio 2,5%; NaOCl 5% - hipoclorito de sódio 5%; CaOCl 1% - hipoclorito de cálcio 1%; CaOCl 2,5% - hipoclorito de cálcio 2,5%; CaOCl 5% - hipoclorito de cálcio 5%. Para cada grupo, irrigação foi realizada com 2 mL de solução. O espaço preparado para pino foi seco com cone de papel absorvente (#80) e os pinos de fibra foram cimentados com cimento resinoso autoadesivo. Os espécimes foram seccionados perpendicularmente e o teste de push-out foi realizado. Microscopia óptica foi usada para analisar o padrão de falha. Os testes de ANOVA e Bonferroni analisaram os dados de resistência adesiva. NaOCl e CaOCl apresentaram similar resistência adesiva, independentemente da concentração usada para irrigar o espaço preparado para pino (p>0,05). SF apresentou os maiores valores de resistência adesiva (11,47 MPa) (p<0,05). Falhas adesivas na interface cimento/dentina foram predominantes (58,33%). Soro fisiológico deve ser o irrigante de escolha para irrigar o espaço preparado para pino antes da cimentação de pinos de fibra com cimentos resinosos autoadesivos. NaOCl e CaOCl afetam negativamente os valores de resistência adesiva.

Influence of the dentin smear layer trait on the bond strength of the self-adhesive resin cements / 华西口腔医学杂志

OBJECTIVE@#This work aimed to evaluate the influence of smear layer on the bonding effectiveness and durability of the self-adhesive resin cements to dentin.@*METHODS@#A total of 48 fresh caries-free third molars with exposed dentin surface were divided into two groups. The dentin surfaces were treated using a standard grit diamond bur (group A) or further polished using a fine grit diamond bur (group B) and then bonded with either of the two self-adhesive resin cements, namely, Clearfil SA Cement (CSA, Kuraray) and Multilink Speed (MS, Ivoclar Vivadent). After 24 h or 2-year water storage, a microtensile bond strength test was performed.@*RESULTS@#In group A, the dentin surface was rough, the smear layer was thick, and the dentin tubule orifice detritus showed low embolism value. In group B, the dentin surface roughness decreased, the embolism proportion increased, and the smear layer became thin. The initial bonding strengths of CSA and MS in group A were significantly lower than those in group B (P0.05).@*CONCLUSIONS@#The properties of the smear layer and the types of self-adhesive resin cement used affected the bond strength and durability.

Research on bond durability among different core materials and zirconia ceramic cemented by self-adhesive resin cements / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This research estimated shear bond durability of zirconia and different substrates cemented by two self-adhesive resin cements (Clearfil SA Luting and RelyX U100) before and after aging conditioning.</p><p><b>METHODS</b>Machined zirconia ceramic discs were cemented with four kinds of core material (cobalt-chromium alloy, flowable composite resin core material, packable composite resin, and dentin) with two self-adhesive resin cements (Clearfil SA Luting and RelyX U100). All specimens were divided into eight test groups, and each test group was divided into two subgroups. Each subgroup was subjected to shear test before and after 10 000 thermal cycles.</p><p><b>RESULTS</b>All factors (core materials, cements, and thermal cycle) significantly influenced bond durability of zirconia ceramic (P<0.00 1). After 10 000 thermal cycles, significant decrease was not observed in shear bond strength of cobalt-chromium alloy luted with Clearfil SA Luting (P>0.05); observed shear bond strength was significantly higher than those of other substrates (P<0.05). Significantly higher shear bond strength was noted in Clearfil SA Luting luted with cobalt-chromium alloy, flowable composite resin core material, and packable composite resin than that of RelyX U100 (P<0.05). However, significant difference was not observed in shear bond strength of dentin luted with Clearfil SA Luting and RelyX U100 (P>0.05).</p><p><b>CONCLUSIONS</b>Different core materials and self-adhesive resin cements can significantly affect bond durability of zirconia ceramic. 
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Effect of atmospheric plasma versus conventional surface treatments on the adhesion capability between self-adhesive resin cement and titanium surface

PURPOSE: The aim of this study was to evaluate the effects of atmospheric plasma (APL) versus conventional surface treatments on the adhesion of self-adhesive resin cement to Ti-6Al-4V alloy. MATERIALS AND METHODS: Sixty plates of machined titanium (Ti) discs were divided into five groups (n=12): 1) Untreated (CNT); 2) Sandblasted (SAB); 3) Tribochemically treated (ROC); 4) Tungsten CarbideBur (TCB); 5) APL treated (APL). SEM analysis and surface roughness (Ra) measurements were performed. Self-adhesive resin cement was bonded to the Ti surfaces and shear bond strength (SBS) tests, Ra and failure mode examinations were carried out. Data were analyzed by one-way analysis of variance and chi-squared test. RESULTS: The lowest SBS value was obtained with CNT and was significantly different from all other groups except for APL. The ROC showed the highest SBS and Ra values of all the groups. CONCLUSION: It was concluded that the effect of APL on SBS and Ra was not sufficient and it may not be a potential for promoting adhesion to titanium.

Effect of Surface Treatment of Fiberglass Posts on Bond Strength to Root Dentin

This study evaluated the influence of the surface treatments of fiberglass posts on bond strength to root dentin using push-out test. Forty bovine incisor roots were endodontically treated. The surface of the fiberglass posts (Exacto #2, Angelus) were treated using 4 different protocols (n=10): Control - 70% ethanol for 1 min; 37% phosphoric acid for 1 min; 10% hydrofluoric acid for 1 min; and 24% hydrogen peroxide for 1 min. After a silane coupling agent was applied for 1 min and all posts were cemented using self-adhesive resin cement (RelyX Unicem, 3M-ESPE). The roots were sectioned and two 1-mm-thick slices were obtained from each third: cervical, middle and apical. The specimens were subjected to the push-out test with a crosshead speed of 0.5 mm/min. Data were analyzed by repeated measures ANOVA followed by Tukey's HSD tests (=0.05). The surface treatment (p<0.001) and root third region (p=0.007) factors were significant. The retention to root canal was affected by surface treatment type. The post surface treatment with 24% hydrogen peroxide for 1 min yielded significantly higher bond strength when the fiberglass posts were cemented with RelyX Unicem.

Este estudo avaliou a influência de tratamentos de superfície de pinos de fibra de vidro na resistência de união à dentina radicular por meio do teste de push-out. Quarenta raízes de incisivos bovinos foram submetidas a tratamento endodôntico. A superfície dos pinos de fibra de vidro (Exacto #2, Angelus) foram tratadas com 4 protocolos diferentes (n=10): Controle - 70 % de etanol durante 1 min; 37 % de ácido fosfórico durante 1 min, 10% de ácido fluorídrico durante 1 min e 24 % de peróxido de hidrogênio durante 1 min. Depois foi aplicado agente de união silano por 1 min e todos os pinos foram cimentados com cimento resinoso auto-adesivo (RelyX Unicem, 3M- ESPE). As raízes foram seccionadas e foram obtidas duas fatias de 1 mm de espessura em cada terço: cervical, médio e apical. Os espécimes foram submetidos ao teste de push-out com uma velocidade de 0.5 mm/min. Os dados foram analisados pelo teste ANOVA com medidas repetidas, seguido pelo teste de Tukey HSD (=0,05). Os fatores tratamento de superfície (p<0,001) e região do terço radicular (p=0,007) foram significantes; no entanto, a interação entre os dois fatores não foi significante (p=0,827). A retenção ao canal radicular foi afetada pelo tipo de tratamento de superfície. O tratamento de superfície com 24% de peróxido de hidrogênio por 1 min rendeu significativamente maior resistência de união quando os pinos de fibra de vidro foram cimentados com RelyX Unicem.

The effect of dentin desensitizers and Nd:YAG laser pre-treatment on microtensile bond strength of self-adhesive resin cement to dentin

PURPOSE: The purpose of this study is to evaluate if pre-treatment with desensitizers have a negative effect on microtensile bond strength before cementing a restoration using recently introduced self-adhesive resin cement to dentin. MATERIALS AND METHODS: Thirty-five human molars' occlusal surfaces were ground to expose dentin; and were randomly grouped as (n=5); 1) Gluma-(Glutaraldehyde/HEMA) 2) Aqua-Prep F-(Fluoride), 3) Bisblock-(Oxalate), 4) Cervitec Plus-(Clorhexidine), 5) Smart protect-(Triclosan), 6) Nd:YAG laser, 7) No treatment (control). After applying the selected agent, RelyX U200 self-adhesive resin cement was used to bond composite resin blocks to dentin. All groups were subjected to thermocycling for 1000 cycles between 5-55degrees C. Each bonded specimen was sectioned to microbars (6 mm x 1 mm x 1 mm) (n=20). Specimens were submitted to microtensile bond strength test at a crosshead speed of 0.5 mm/min. Kolmogorov-Smirnov, Levene's test, Kruskal-Wallis One-way Analysis of Variance, and Conover's nonparametric statistical analysis were used (P.05). The microtensile bond strengths of Aqua-Prep F, and Cervitec Plus were similar to each other but significantly lower than the control group (P<.05). Bisblock showed the lowest microtensile bond strength among all groups (P<.001). Most groups showed adhesive failure. CONCLUSION: Within the limitation of this study, it is not recommended to use Aqua-prep F, Cervitec Plus and Bisblock on dentin when used with a self-adhesive resin cement due to the decrease they cause in bond strength. Beside, pre-treatment of dentin with Gluma, Smart protect, and Nd:YAG laser do not have a negative effect.

Effects of dentin moisture on the push-out bond strength of a fiber post luted with different self-adhesive resin cements

OBJECTIVES: This study evaluated the effects of intraradicular moisture on the pushout bond strength of a fibre post luted with several self-adhesive resin cements. MATERIALS AND METHODS: Endodontically treated root canals were treated with one of three luting cements: (1) RelyX U100, (2) Clearfil SA, and (3) G-Cem. Roots were then divided into four subgroups according to the moisture condition tested: (I) dry: excess water removed with paper points followed by dehydration with 95% ethanol, (II) normal moisture: canals blot-dried with paper points until appearing dry, (III) moist: canals dried by low vacuum using a Luer adapter, and (IV) wet: canals remained totally flooded. Two 1-mm-thick slices were obtained from each root sample and bond strength was measured using a push-out test setup. The data were analysed using a two-way analysis of variance and the Bonferroni post hoc test with p = 0.05. RESULTS: Statistical analysis demonstrated that moisture levels had a significant effect on the bond strength of luting cements (p Clearfil SA > G-Cem. CONCLUSIONS: The degree of residual moisture significantly affected the adhesion of luting cements to radicular dentine.

Microtensile bond strength of self-etching and self-adhesive resin cements to dentin and indirect composite resin / 대한치과보존학회지

The purpose of this study was to evaluate the microtensile bond strength (microTBS), failure modes and bonding interfaces of self-etching and three self-adhesive resin cements to dentin and indirect composite resin. Cylindrical composite blocks (Tescera, Bisco Inc.) were luted with resin cements (PA: Panavia F 2.0, Kuraray Medical Inc., RE: RelyX Unicem Clicker, 3M ESPE., MA: Maxem, Kerr Co., BI: BisCem, Bisco Inc.) on the prepared occlusal dentin surfaces of 20 extracted molars. After storage in distilled water for 24 h, 1.0 mm x 1.0 mm composite-dentin beams were prepared. microTBS was tested at a cross-head speed of 0.5 mm/min. Data were analyzed with one-way ANOVA and Tukey's HSD test. Dentin sides of all fractured specimens and interfaces of resin cements-dentin or resin cements-composite were examined at FE-SEM (Field Emission-Scanning Electron Microscope). In conclusion, PA and RE showed higher bond strength and closer adaptation than MA and BI when indirect composite blocks were luted to dentin using a self-etching and three self-adhesive resin cements.

Physical properties of different self-adhesive resin cements and their shear bond strength on lithium disilicate ceramic and dentin / 대한치과보존학회지

The purpose of this study was to evaluate the physical properties of different self-adhesive resin cements and their shear bond strength on dentin and lithium disilicate ceramic and compare these result with that of conventional resin cement. For this study, four self-adhesive resin cements (Rely-X Unicem, Embrace Wetbond, Mexcem, BisCem), one conventional resin cement (Rely-X ARC) and one restorative resin composite (Z-350) were used. In order to evaluate the physical properties, compressive strength, diametral tensile strength and flexural strength were measured. To evaluate the shear bond strength on dentin, each cement was adhered to buccal dentinal surface of extracted human lower molars. Dentin bonding agent was applied after acid etching for groups of Rely-X ARC and Z-350. In order to evaluate the shear bond strength on ceramic, lithium disilicate glass ceramic (IPS Empress 2) disks were prepared. Only Rely-X ARC and Z-350 groups were pretreated with hydrofluoric acid and silane. And then each resin cement was adhered to ceramic surface in 2 mm diameter. Physical properties and shear bond strengths were measured using a universal testing machine. Results were as follows 1. BisCem showed the lowest compressive strength, diametral tensile strength and flexural strength. (P<0.05) 2. Self-adhesive resin cements showed significantly lower shear bond strength on the dentin and lithium disilicate ceramic than Rely-X ARC and Z-350 (P<0.05) In conclusion, self-adhesive resin cements represent the lower physical properties and shear bond strength than a conventional resin cement.

The study of shear bond strength of a self-adhesive resin luting cement to dentin / 대한치과보철학회지

PURPOSE: The objective of this study was to compare the bonding characteristics of a new self-adhesive resin cement to dentin, which does not require bonding and conditioning procedure of the tooth surface, and conventional resin cement. The effect of phosphoric acid etching prior to application of self-adhesive resin cement on the shear bond strength was also evaluated. MATERIAL AND METHODS: Fortyfive non-carious human adult molars extracted within 6 months were embedded in chemically cured acrylic resin. The teeth were ground with a series of SiC-papers ending with 800 grit until the flat dentin surfaces of the teeth were exposed. The teeth were randomly divided into 3 experimental groups. In group 1, self-adhesive resin cement, RelyX Unicem (3M ESPE, Seefeld, Germany) was bonded without any conditioning of teeth. In group 2, RelyX Unicem was bonded to teeth after phosphoric acid etching. For group 3, Syntac Primer (Ivoclar Vivadent AG, Schaan, Liechtenstein) was applied to the teeth before Syntac adhesive (Ivoclar Vivadent AG, Schaan, Liechtenstein) and Helibond (Ivoclar Vivadent AG, Schaan, Liechtenstein) followed by conventional resin cement, Variolink II (Ivoclar Vivadent AG, Schaan, Liechtenstein). To make a shear bond strength test model, a plastic tuble (3 mm diameter, 3 mm height) was applied to the dentin surfaces at a right angle and filled it with respective resin cement, and light-polymerized for 40 seconds. All the specimens were stored in distilled water at 37 degree C for 24 hours before test. Universal Testing Machine (Z020, Zwick, Ulm, Germany) at a cross head speed of 1 mm/min was used to evaluate the shear bond strength. The failure sites were inspected under a magnifier and Scanning Electron Microscope. The data was analyzed with One way ANOVA and Scheffe test at alpha = 0.05. RESULTS: (1) The shear bond strengths to dentin of RelyX Unicem was not significantly different from those of Variolink II/Syntac. (2) Phosphoric acid etching lowered the shear bond strength of RelyX Unicem significantly. (3) Most of RelyX Unicem and Variolink II showed mixed fractures, while all the specimens of RelyX Unicem with phosphoric acid etching demonstrated adhesive failure between dentin and resin cement. CONCLUSION: Shear bond strength to dentin of self-adhesive resin cement is not significantly different from conventional resin cement, and phosphoric acid etching decrease the shear bond strength to dentin of self-adhesive resin cement.

Microleakage of resilon by methacrylate-based sealer and self-adhesive resin cement / 대한치과보존학회지

The purpose of this study was to compare the apical microleakage in root canal filled with Resilon by methacrylate-based root canal sealer or 2 different self-adhesive resin cements. Seventy single-rooted extracted human teeth were sectioned at the CEJ perpendicular to the long axis of the roots with diamond disk. Canal preparation was performed with crown-down technique using Profile NiTi rotary instruments and GG drill. Each canal was prepared to ISO size 40, .04 taper and 1 mm short from the apex. The prepared roots were randomly divided into 4 experimental groups of 15 roots each and 5 roots each for positive and negative control group. The root canals were filled by lateral condensation as follows. Group 1: Guttapercha with AH-26, Group 2: Resilon with RealSeal primer & sealer, Group 3: Resilon with Rely-X Unicem, Group 4: Resilon with BisCem. After stored in 37degrees C, 100% humidity chamber for 7 days, the roots were coated with 2 layers of nail varnish except apical 3 mm. The roots were then immersed in 1% methylene blue dye for 7 days. Apical microleakage was measured by a maximum length of linear dye penetration after roots were separated longitudinally. One way ANOVA and Scheffe's post-hoc test were performed for statistical analysis. Group 1 showed the least apical leakage and there was no statistical significance between Group 2, 3, 4. According to the results, the self adhesive resin cement is possible to use as sealer instead of primer & sealant when root canal filled by Resilon.