Evaluation of signs, symptoms, and occlusal factors among patients with temporomandibular disorders according to Helkimo index.

Objective: This study sought to assess the clinical signs and subjective symptoms of TMD, including the occlusal condition. Methods: Recruited individuals included 123 patients (58 men, 65 women) aged 15 to 65 years (mean 38.6 years) who had been referred to the TMD department. Helkimo dysfunction, occlusal, and anamnestic indices were used to assess signs of TMD, occlusal condition, and symptoms, respectively. Relationships of occlusal factors with signs and symptoms of TMD were evaluated by Spearman's correlation test. Associations of TMD with sex and age distributions were assessed by Mann-Whitney and Spearman's test, respectively. Results: The prevalence of signs and symptoms was as high as 75%. Occlusal factors had significant associations with signs and symptoms of TMD. Conclusion: Prevalence of TMD in the study population was high, without preference for age or sex. Occlusal factors may play a role in the etiology of TMD.

Microtensile Bond Strength of a Resin Cement to Silica-Based and Y-TZP Ceramics Using Different Surface Treatments.

PURPOSE: To evaluate the effects of different surface treatments on the microtensile bond strength (µTBS) of bonding between resin cement and lithia or zirconia-based ceramics using an in vitro study. MATERIALS AND METHODS: Three zirconia ceramic blocks (IPS e.max ZirCAD) and three lithium disilicate ceramic blocks (IPS e.max CAD) were sintered and duplicated in resin composite. The zirconia specimens underwent various treatments (n = 1): (i) Sandblast + primer (ZiSa); (ii) sandblast + laser irradiation + primer (ZiSaLa); or (iii) laser irradiation + primer (ZiLa). The lithium disilicate specimens also underwent various treatments: (i) sandblast + HF + silane (LiSaE); (ii) sandblast + silane (LiSa); or (iii) sandblast + laser irradiation + silane (LiSaLa). The ceramic-composite blocks were cemented with resin cement and cut to produce bars with approx. 1 mm2 bonding areas. The specimens were thermocycled, and bond strength tests were performed in a universal testing machine. The fracture type was determined by observing the fractured surface under a stereomicroscope. The mean bond strengths of the specimens were statistically analyzed using one-way ANOVA and Duncan's tests (α = 0.05). RESULTS: Mean comparison of the µTBS showed no significant difference between LiSaE and LiSa (p > 0.05), but significant differences between LiSaE and other groups (p ≤ 0.01). No significant differences were found between the ZiSaLa and ZiSa groups (p > 0.05). The modes of failure in all groups were mostly adhesive (57% to 80%). The mean bond strengths in laser-irradiated ceramics were significantly lower than those from other surface treatments. All ZiLa specimens debonded before testing (pretest failure). CONCLUSIONS: Lithium disilicate ceramic surface treated with a combination of sandblasting and silane application provided a bond strength comparable to that provided by sandblasting in combination with acid etching and applying silane. Groups treated with laser irradiation had significantly lower bond strengths than other groups.

Marginal leakage and microhardness evaluation of low-shrinkage resin-based restorative materials.

This study sought to compare the marginal leakage and microhardness of low-shrinkage resin-based dental restorative materials containing ormocer- and silorane-based composites to that of conventional methacrylate-based systems. A total of 50 noncarious extracted human teeth were collected after debridement and standard Class V cavities were prepared. Teeth were randomly assigned to five groups (n = 10) and restored with 5 types of resin-based restorative material composites: hybrid, microhybrid, nanohybrid, ormocer-based, and silorane-based. After thermocycling, all teeth were placed in a silver nitrate solution, sectioned longitudinally in a buccolingual direction, and observed under a stereomicroscope to determine the degree of dye penetration. Data were analyzed using a non-parametric Kruskal-Wallis test (P < 0.05). For the microhardness test, five specimens were made for each restorative material, using Teflon molds with disk-shaped specimen wells. Specimens were photocured and placed in distilled water (at 37°C) for 24 hours. Vickers Hardness Number (VHN) measurements were performed using a microhardness tester. Data were analyzed by one-way ANOVA and Bonferroni post hoc tests. In terms of microhardness, there was no statistically significant difference among the resin-based restorative materials (P > 0.05). The degree of microleakage at the gingival margins was lowest for the silorane composite, followed by microhybrid and nanohybrid. The silorane composite was significantly lower than that of the ormocer and hybrid composites (P < 0.05). Based on the results of this study, it was concluded that the silorane-based composite material could provide a marginal seal comparable to that provided by microhybrid or nanohybrid resin composites.

Bond strength of a dental leucite-based glass ceramic to a resin cement using different silane coupling agents.

AIM: To evaluate the effect of different types of novel silane coupling agents with two concentrations on the micro-tensile bond strength of a dental glass ceramic with leucite crystals to a dual-cured resin cement using an optimized method of silane application. METHODS: Leucite-reinforced feldspathic ceramic blocks were fabricated, wet ground and cleansed. The bonding ceramic surfaces were treated with different organosilane solutions as follows: Control silane: Monobond S; methacryloxypropyltrimethoxy silane and experimental silanes with two concentrations (1.0 and 2.5 vol%): amino, isocyanate, styryl, and acrylate silanes. The silane application method consisted of brush application, hot air drying followed by rinsing with hot water and drying. Then a thin layer of an unfilled resin and a dual-cured resin cement was light-cured on the ceramic surfaces. The resin-ceramic blocks were stored in distilled water at 37°C for 24 h and sectioned to produce beam specimens (n=17) with a 1.0 mm(2) cross-sectional area. Specimens were then subjected to thermocycling and tested in a micro-tensile tester device. Data were analyzed using analysis of variance and Tamhane post-hoc test. RESULTS: The mean micro-tensile bond strength value for the styryl silane was significantly higher (P<0.05) than the other types of silanes except for the Monobond S. The mean bond strength values for isocyanate silanes were significantly lower than the other silanes tested (P<0.05). No statistically significant difference in the bond strength between the 1.0 and 2.5 vol% of experimental silanes was observed (P>0.05). CONCLUSIONS: The micro-tensile bond strength of the leucite-based dental glass ceramic to a resin cement was affected by the type of silane coupling agent and not by the concentration of silane solutions. The best bond strength overall was achieved by methacryloxypropyltrimethoxysilane and experimental styryl silane solutions.

Interfacial fracture toughness of different resin cements bonded to a lithium disilicate glass ceramic.

OBJECTIVES: To evaluate the effect of HF acid etching and silane treatment on the interfacial fracture toughness of a self-adhesive and two conventional resin-based cements bonded to a lithium disilicate glass ceramic. METHODS: Lithium disilicate glass ceramic discs were prepared with two different surface preparations consisting of gritblasted with aluminium oxide, and gritblasted and etched with hydrofluoric acid. Ceramic surfaces with a chevron shaped circular hole were treated by an optimized silane treatment followed by an unfilled resin and then three different resin cements (Variolink II, Panavia F2, and Multilink Sprint). Specimens were kept in distilled water at 37°C for 24h and then subjected to thermocycling. The interfacial fracture toughness was measured and mode of failures was also examined. Data were analysed using analysis of variance followed by T-test analysis. RESULTS: No statistically significant difference in the mean fracture toughness values between the gritblasted and gritblasted and etched surfaces for Variolink II resin cement was found (P>0.05). For the gritblasted ceramic surfaces, no significant difference in the mean fracture toughness values between Panavia F2 and Variolink II was observed (P>0.05). For the gritblasted and etched ceramic surfaces, a significantly higher fracture toughness for Panavia F2 than the other cements was found (P<0.05). CONCLUSIONS: The interfacial fracture toughness for the lithium disilicate glass ceramic system was affected by the surface treatment and the type of luting agent. Dual-cured resin cements demonstrated a better bonding efficacy to the lithium disilicate glass ceramic compared to the self-adhesive resin cement. CLINICAL SIGNIFICANCE: The lithium disilicate glass ceramic surfaces should be gritblasted and etched to get the best bond when used with Panavia F2 and Multilink Sprint resin cements, whereas for the Variolink II only gritblasting is required. The best bond overall is achieved with Panavia F2.

Marginal gap, internal fit, and fracture load of leucite-reinforced ceramic inlays fabricated by CEREC inLab and hot-pressed techniques.

PURPOSE: This in vitro study was designed to evaluate and compare the marginal gap, internal fit, and fracture load of resin-bonded, leucite-reinforced glass ceramic mesio-occlusal-distal (MOD) inlays fabricated by computer-aided design/manufacturing (CAD/CAM) or hot pressing. MATERIALS AND METHODS: Fifty caries-free extracted human molars were prepared for standardized MOD inlays. Impressions of each specimen were made and poured using type IV dental stone. Dies were randomly divided into two equal groups. Twenty-five ceramic inlays were fabricated by the hot-pressed technique using IPS Empress leucite-reinforced glass ceramics, and the other 25 ceramic inlays were produced by CAD/CAM technology using ProCAD leucite-reinforced ceramic blocks and CEREC inLab facilities. Inlays were bonded to the teeth using a dual-cured resin cement. The specimens were stored in distilled water at 37°C for 24 hours and then thermocycled for 5000 cycles. The marginal gap measurements were taken with a stereomicroscope. Specimens in each group of inlay systems were randomly divided into two subgroups of 10 and 15 specimens each. Ten specimens in each subgroup were sectioned mesiodistally for evaluation of the internal fit. The fracture load of specimens in the second subgroup (n = 15) of the two inlay systems was determined under compressive load in a universal testing machine. Data were analyzed using Student's t-test at a significance level of p < 0.05. RESULTS: The mean marginal and internal gap size in both IPS Empress and ProCAD inlays were less than 100 µm; however, the marginal gap for the IPS Empress restorations was significantly higher than that of ProCAD restorations (p < 0.05). There was no significant difference in the mean internal fit or the fracture load between the two glass ceramic inlays (p > 0.05). CONCLUSIONS: The leucite-reinforced glass ceramic inlay restorations fabricated by CEREC inLab (CAD/CAM) and the hot-pressed technique provided clinically acceptable marginal and internal fit with comparable fracture loads after luting.

Microhardness of a resin cement polymerized by light-emitting diode and halogen lights through ceramic.

PURPOSE: This study evaluated the curing efficiency of light-emitting diode (LED) and halogen [quartz tungsten halogens (QTH)] lights through ceramic by determining the surface microhardness of a highly filled resin cement. MATERIALS AND METHODS: Resin cement specimens (Variolink Ultra; with and without catalyst) (5-mm diameter, 1-mm thick) were condensed in a Teflon mold. They were irradiated through a ceramic disc (IPS Empress 2, diameter 5 mm, thickness 2 mm) by high-power light-curing units as follows: (1) QTH for 40 seconds (continuous), (2) LED for 20 seconds, and (3) LED for 40 seconds (5-second ramp mode). The specimens in control groups were cured under a Mylar strip. Vickers microhardness was measured on the top and bottom surfaces by a microhardness tester. Data were analyzed using analysis of variance (ANOVA) and a post hoc Bonferroni test at a significance level of p < 0.05. RESULTS: The mean microhardness values of the top and bottom surfaces for the dual-cured cement polymerized beneath the ceramic by QTH or LED (40 seconds) were significantly higher than that of light-cured cement (p < 0.05). The top and bottom surface microhardness of dual-cured cement polymerized beneath the ceramic did not show a statistically significant difference between the LED and QTH for 40 seconds (p > 0.05). CONCLUSIONS: The efficiency of high-power LED light in polymerization of the resin cement used in this study was comparable to the high-power QTH light only with a longer exposure time. A reduced curing time of 20 seconds with high-power LED light for photopolymerizing the dual-cured resin cement under ceramic restorations with a minimum 2-mm thickness is not recommended.

Effect of surface acid etching on the biaxial flexural strength of two hot-pressed glass ceramics.

PURPOSE: The purpose of this study was to assess the effect of surface acid etching on the biaxial flexural strength of two hot-pressed glass ceramics reinforced by leucite or lithium disilicate crystals. MATERIALS AND METHODS: Forty glass ceramic disks (14-mm diameter, 2-mm thick) consisting of 20 leucite-based ceramic disks (IPS Empress) and 20 lithia disilicate-based ceramic (IPS Empress 2) were produced by hot-pressing technique. All specimens were polished and then cleaned ultrasonically in distilled water. Ten specimens of each ceramic group were then etched with 9% hydrofluoric (HF) acid gel for 2 minutes and cleaned ultrasonically again. The biaxial flexural strength was measured by the piston-on-three-ball test in a universal testing machine. Data based on ten specimens in each group were analyzed by two-way ANOVA (alpha= 0.05). Microstructure of ceramic surfaces before and after acid etching was also examined by a scanning electron microscope. RESULTS: The mean biaxial flexural strength values for each group tested were (in MPa): nonetched IPS Empress = 118.6 +/- 25.5; etched IPS Empress = 102.9 +/- 15.4; nonetched IPS Empress 2 = 283.0 +/- 48.5; and etched IPS Empress 2 = 250.6 +/- 34.6. The results showed that the etching process reduced the biaxial flexural strengths significantly for both ceramic types (p= 0.025). No significant interaction between the ceramic type and etching process was found (p= 0.407). CONCLUSION: From the results, it was concluded that surface HF acid etching could have a weakening effect on hot-pressed leucite or lithia disilicate-based glass ceramic systems.

Fracture toughness of a ceramic-resin interface.

OBJECTIVES: The purpose of this study was to compare the interfacial fracture toughness of smooth and roughened ceramic surfaces bonded with a luting resin using an optimized method of silane treatment. METHODS: Ceramic discs were prepared with four different surface preparations (n=20) consisting of (1) polished, (2) gritblasted, (3) hydrofluoric acid etched and (4) gritblasted and etched. The ceramic discs were then covered by a PTFE tape with a chevron shaped circular hole. The exposed surfaces were treated by an optimized silane treatment followed by an unfilled resin and then a luting resin. Specimens were then stored in distilled water at 37 degrees C for (A) 24h and (B) 30 days. The interfacial fracture toughness was measured, the mode of failure and fracture surfaces were also examined under a stereo-zoom microscope and a scanning electron microscope. RESULTS: One-way ANOVA showed that there was no statistically significant difference in the mean interfacial fracture toughness for groups A1-A4 (P>0.05). However, the mean interfacial fracture toughness for group B1 was significantly different from that for groups B2, B3 and B4 (P<0.05). Independent-samples t-test results showed that there was a significant increase in the G(Ic) mean value for groups B2 and B3 after 30 days water storage (P<0.05). The modes of failure were predominantly interfacial or cohesive within the resin. SIGNIFICANCE: It can be concluded that micro-mechanical retention by gritblasting the ceramic surfaces could be sufficient with no need for HF acid etching the ceramic surfaces when an appropriate silane application procedure is used.

Storage effect of a pre-activated silane on the resin to ceramic bond.

OBJECTIVES: The purpose of this study was to investigate the process of hydrolysis and chemical stability of a pre-activated silane solution stored for different periods of time. The tensile bond strength of resin composite to ceramic was also evaluated in order to determine the functional effectiveness after storage of the pre-activated silane solutions. METHODS: Silane solutions using gamma-methacryloxypropyltrimethoxysilane (gamma-MPTS), acetic acid and ethanol were freshly prepared and kept for 15 min, 2 h, 24 h, 1 week, 1 month, 6 months, and 1 year. The solutions were analyzed using a 2000 Perkin-Elmer Fourier transform infrared (FT-IR) spectrophotometer. For the tensile bond strength test, Ni/Cr rods were prepared with ceramic facings polished to 1 microm. Five groups of ceramic surfaces (n = 60) were treated with the pre-activated silane solutions and bonded using a luting resin. The process used to prepare the surfaces prior to bonding consisted of removing unreacted silane by boiling water and then heat treatment. Each group was then subdivided into two groups (n = 30) and stored under two different storage conditions before subjecting to the tensile bond strength test; either (1) dry at room temperature for 24 h or (2) boiling water for 24 h. RESULTS: FT-IR analysis showed that nearly complete hydrolysis of gamma-MPTS has occurred 24 h after mixing, followed more slowly by the formation of siloxane (Si-O-Si) oligomers. The bond strength test results showed that there was no statistically significant difference in the mean tensile bond strength for any of the groups either in dry condition or in boiling water (P > 0.05). The mode of failure for all groups was predominantly cohesive failure within the resin. The silane bond was also capable of resisting hydrolytic attack in boiling water for all the groups. SIGNIFICANCE: From the results of this study it can be concluded that, when using an appropriate silane application technique, the adhesive effectiveness of a pre-activated silane solution based on gamma-MPTS, acetic acid and ethanol will not deteriorate when stored for up to 1 year at room temperature.

Comparison of the replicability of routinely used centric relation registration techniques.

PURPOSE: This study was conducted to determine statistically the most repeatable mandibular position of 3 centric relation methods. MATERIALS AND METHODS: Three centric relation recording methods commonly reported in the literature were selected: bimanual mandibular manipulation with a jig, chin point guidance with a jig, and Gothic arch tracing. Fourteen healthy adult volunteers (7 males and 7 females), with an average age of 26.61 +/- 4.20 years and no history of extractions, temporomandibular joint dysfunction, or orthodontic treatment, were selected for the study. Accurate casts were mounted on an articulator (Denar D4A) by means of a facebow and maximum intercuspation silicone registration record. A mechanical 3-dimensional mandibular position indicator was constructed and mounted on the articulator enabling the operator to analyze the mandibular positions in 3 spatial axes (x, anteroposterior; y, superoinferior; z, mediolateral shift). Each centric relation method was recorded four times on each subject (at baseline, 1 hour, 1 day, and 1 week at approximately the same time of day). Records were transferred to the articulator, and data were extracted using a stereomicroscope modified to accept the mandibular position indicator. RESULTS: Variability within subjects ranged from 0.03 mm (left-side z axis for the bimanual method) to 1.6 mm (left-side y axis for the Gothic arch method). To indicate the least variable (most repeatable) method a comparison was made using the F test. The bimanual method was the most consistent, showing between 10.11 (p = 1) and 0.438 (p = 0.005) times less variation than the Gothic arch method (the least consistent). The repeatability of the chin point guidance method was somewhere between the other 2 methods. CONCLUSIONS: The results of this study showed that of the 3 centric relation methods evaluated, the bimanual manipulation method positioned the condyles in the temporomandibular joint with a more consistent repeatability than the other 2 methods, whereas the Gothic arch was the least consistent method.

Bond durability of the resin-bonded and silane treated ceramic surface.

OBJECTIVES: The aim of this study was to explore methods for improving the ceramic-silane-resin bond strength of silica-based ceramics, such that it may be possible to eliminate the hazardous process of acid etching these dental ceramics with hydrofluoric acid (HF). METHODS: Ni/Cr rods were prepared with ceramic facings, which were polished to a 1 microm finish. A silane coupling agent was applied to the ceramic surface using seven different procedures. Specimens were bonded using a luting resin and the tensile bond strength was measured at a crosshead speed of 1mm/min. One bonding procedure was selected and used for the comparison of four ceramic surface preparations consisting of; 1 microm polish, gritblasted (50 microm alumina), etched with 10% HF, and gritblasted and etched. The durability of the bond was assessed by (1) storing the specimens in water at 37 degrees C for different time periods up to 3 months, (2) thermal cycling, and (3) storing in water at 100 degrees C for 24h. RESULTS: The results showed that one bonding procedure to a polished ceramic surface gave better results for the tensile bond strength of the resin to the smooth ceramic surface and that the tensile bond strength was not significantly different from the gritblasted, etched or gritblasted and etched groups (P>0.05). There was no deterioration in the tensile bond strength for any of the groups after water storage for up to 3 months or after thermal cycling (P>0.05). The silane bond was also capable of resisting hydrolytic attack in boiling water. SIGNIFICANCE: The results indicate that a durable resin-ceramic tensile bond can be obtained by appropriate silane application without the need for HF acid etching the ceramic surface.