The Use of CAD/CAM Cobalt-Chromium Framework to Optimize Subgingival Prosthetic Contours and Improve Esthetics: Anterior Mandibular Case Reports.

Although implant therapy in esthetically relevant areas is currently based on a prosthetically driven philosophy, anatomical and technical factors may impair ideal implant placement. In these scenarios, the clinician is frequently asked to solve the discrepancy between the implant emergence and the ideal coronal anatomy of the final restoration. This report describes how changes of the implant abutment-crown contour in specific locations may be intentionally promoted to determine improvements of the peri-implant soft tissues and overall esthetic integration. Cobalt-chromium alloys together with computer-aided design/computer-assisted manufacture technologies are critical factors in achieving this goal. Case reports for the mandibular anterior dentition demonstrated the ability to enhance biologic and esthetic results of malpositioned implants.

The Evaluation of Unscrewing Torque Values of Implant-Abutment Connections: An In Vitro Study.

PURPOSE: This study investigated the stability of titanium screws in implant-abutment connections by measuring the force necessary to induce unscrewing. MATERIALS AND METHODS: A total of 60 implant-abutment couplings were assigned to two groups (n = 30 each). The sequence 10-20-32 Ncm was tested in Group 1; the sequence 10-20-32-32-32 Ncm was tested in Group 2. The force necessary to unscrew each abutment-implant sample was recorded and statistically analyzed. The significance level was set at P < .05. RESULTS: Significant differences were found between the two sequences. Group 2 required higher forces than Group 1 to unscrew. CONCLUSION: The stability of the implant-abutment joint may be improved by tightening with the sequence 10-20-32-32-32 Ncm.

The use of bonded partial ceramic restorations to recover heavily compromised teeth.

Restorative procedures are accompanied by a reduction of tooth stability, a decrease of fracture resistance, and an increase in deflection of weakened cusps. The choice between a direct or an indirect restorative technique, mainly in posterior areas, is a challenge, and involves biomechanical, anatomical, functional, esthetic, and financial considerations. In this article, the pros and cons of direct restorations are examined, as well as an analysis of indirect restorations and an overview of dental ceramics. In particular, several clinical uses of lithium disilicate overlays with a circumferential adhesive ferrule effect are proposed: heavily compromised vital teeth with thin walls, cracked teeth, and endodontically treated molars. Clinical procedures are described step by step on the basis of data from scientific literature. In conclusion, the use of lithium disilicate in combination with adhesive technologies can lead to a more conservative, economic, and esthetic approach in the restoration of heavily compromised teeth.

Effect of 2 impression techniques on the dimensional accuracy of working implant prosthesis models: an in vitro study.

PURPOSE: Implant impressions and working models form integrated precision systems for registration and transmission of clinical data. The components of implant systems have a dimensional tolerance capable of introducing inaccuracies in the impression, thus in the prosthetic framework. This article aimed at comparing 2 repositioning impression techniques: one using impression copings (conventional technique) and the other using the final abutments as impression copings (interceptive technique). MATERIALS AND METHODS: Two experimental models, one with 4 parallel implants and the other with 4 nonparallel implants, were used to make silicone impressions. Twenty impressions were made with the conventional technique, and a further 20 were made with the interceptive technique. Three-dimensional images acquired with a three-dimensional scanner were measured using a three-dimensional image analysis software, comparing models obtained from the impressions with the experimental models. Data were statistically analyzed by means of confidence intervals calculated with the mean (α = 0.05), descriptive (box plot), and bivariate analyses. RESULTS: Statistic analysis highlighted significant differences among models obtained using both techniques: the interceptive technique generated working models with less distortion and variability. CONCLUSIONS: For internal-connection implants, the interceptive technique provided significantly more precise working models than did the conventional technique.

The evaluation of marginal gap with and without optical aids: clinicians versus technicians.

PURPOSE: This study investigated the reliability of visual assessment of marginal gaps in relation to the use of magnification and the operator's profession. MATERIALS AND METHODS: A titanium bar was notched, simulating 40 marginal gaps, and 35 operators performed a quantitative evaluation of the incisions. RESULTS: Visual examination was neither sensitive nor specific, as an extreme variability of data was recorded. The precision of readers improved with magnification aids only for clinicians; technicians were significantly more accurate in evaluating the incision's width. CONCLUSION: The visual examinations were inadequate to decide the clinical acceptability of a restoration with regard to its marginal fit.

Bonding and sealing ability of a new self-adhering flowable composite resin in class I restorations.

OBJECTIVES: The aim of this study is to assess by means of shear bond strength tests (SBS), microleakage analysis (µLKG), and scanning electron microscopy (SEM) the bonding potential and sealing ability of a new self-adhering composite resin. MATERIALS AND METHODS: SBS and µLKG of Vertise Flow (VF, Kerr) were measured and compared to the all-in-one adhesive systems G-Bond (GB, GC), AdheSE One (AO, Ivoclar Vivadent), Adper Easy Bond (EB, 3M ESPE), Xeno V (XV, Dentsply), and iBOND (iB, Heraeus Kulzer). For each system, 20 molars were tested for SBS on dentin (n = 10) and enamel (n = 10). For µLKG assessment, 12 premolars per group were selected and small, box-shaped cavities were made. After restoration, the teeth were immersed in 50 wt% silver nitrate solution for 24 h. For each group, 10 randomly selected specimens were processed for leakage calculations, while two of the specimens were examined under SEM. Between-group differences in SBS to dentin and µLKG were assessed using Kruskal-Wallis analysis of variance followed by the Dunn's Multiple Range test. Enamel SBS data were analyzed with one-way ANOVA, followed by the Tukey test. RESULTS: On dentin and enamel, VF recorded the lowest SBS values that were statistically comparable to those measured by GB, iB, and AO. µLKG analysis showed the lowest percentage of stained interface for VF. Significantly greater extent of infiltration was seen for iB and EB. CONCLUSIONS: Although VF resulted in lower bond strengths values on either dental substrate, better marginal sealing ability was visualized in comparison with all-in-one adhesive systems. CLINICAL RELEVANCE: The results of the present study demonstrated satisfactory in vitro outcome of the self-adhering flowable composite resin VF when used to restore class I cavities.

Effects of post surface treatments on the bond strength of self-adhesive cements.

PURPOSE: To evaluate whether fiber post surface conditioning techniques would influence the ultimate retentive strength of self-adhesive resin cements into the root canal. METHODS: 50 single-rooted premolars with one root canal were endodontically treated and prepared to receive a fiber post. Five groups were formed (n=10) according to the post surface pre-treatment performed: (1) Silane application (Monobond S) for 60 seconds; (2) 10% hydrogen peroxide application for 20 minutes; (3) Rocatec Pre; (4) Silicate/silane coating (DT Light SL Post); (5) No treatment (DT Light Post). Two self-adhesive resin cements (RelyX Unicem and MaxCem) were used as luting agents. The bonded specimens were stored up to 1 month (37 degrees C and 100% humidity). The force required to dislodge the post (MPa) via an apical-coronal direction was measured with the push-out bond strength test (cross-head speed: 0.5 mm/minute until failure). Failure patterns were evaluated under SEM. Data was statistically analyzed with one-way ANOVA and Tukey tests (P< 0.05). RESULTS: No increase in the push-out bond strength values were observed for RelyX Unicem, independently from the post surface treatment performed. MaxCem attained higher bond strengths when luted to silanated posts.

Effect of surface pre-treatments on the zirconia ceramic-resin cement microtensile bond strength.

OBJECTIVE: To evaluate the influence of different surface treatments on the microtensile bond strength of resin cement to zirconia ceramic. MATERIALS AND METHODS: Twelve cylinder-shaped (∅ 12×5.25 mm high) blocks of a commercial zirconium-oxide ceramic (Cercon® Zirconia, DENTSPLY) were randomly divided into 4 groups (n=3), based on the surface treatment to be performed: (1) airborne particle abrasion with 125 µm Al2O3 particles (S); (2) selective infiltration etching (SIE); (3) experimental hot etching solution applied for 30 min (ST) and (4) no treatment (C). Paradigm MZ100 blocks (3M ESPE) were cut into twelve cylinders of 4mm in thickness. Composite cylinders were bonded to conditioned ceramics using a resin cement (Calibra®, DENTSPLY), in combination with the proprietary adhesive system. After 24h bonded specimens were cut into microtensile sticks and loaded in tension until failure. Bond strength data were analyzed with Kruskall-Wallis and Dunn's Multiple Range test for multiple comparisons (p < 0.05). Failure mode distribution was recorded and the interfacial morphology of debonded specimens was analyzed using a scanning electron microscope (SEM). RESULTS: Bond strength values achieved after SIE and ST treatment were significantly higher than after S treatment and without any treatment (p < 0.05). Premature failures were mostly recorded in the S group. SIGNIFICANCE: Conditioning the high-strength ceramic surface with SIE and ST treatments yielded higher bond strengths of the resin cement than when zirconia ceramic was treated with airborne particle abrasion or left untreated.

Influence of ozone on the composite-to-composite bond.

The study evaluated the effect of ozone application on the composite-to-composite bond. Three hundred and twenty cylindrical composite specimens were divided into two groups: group 1 was subjected to a 60 s ozone application, whereas group 2 remained untreated. Four subgroups were obtained from each group according to the intermediate repair agent: an adhesive, a silane, silane/adhesive combination, or flowable composite. Repair composite cylinders were built-up. The composite repair strength was tested after 24 h and after thermocycling with a shear test. Additionally, 4 mm × 4 mm × 2 mm composite specimens were prepared and stored 24 h in deionized water. Half of the specimens were subjected to ozone application and the other served as control. The elastic modulus (E) and the Vicker's hardness (VH) of the composite surfaces were tested immediately and after thermocycling. Significant differences among the experimental groups were detected (p < 0.001). The composite repair strength was affected by the pretreatment and by the intermediate agent, whereas, the thermocycling was not significant. The partial eta-squared statistics showed that the intermediate agent was the main factor affecting the composite repair strength, whereas the pretreatment played a minor role. No differences were observed between ozone and control groups when the same intermediate agent and the same aging conditions were applied. Repairing with flowable composite tended to achieve higher bond strengths (20.7 and 26.5 MPa in ozone and control groups, respectively, after 24 h). The use of silane coupling agent showed the lowest composite repair strengths. Ozone did not affect E and VH (p > 0.05) and the thermocycling affected only E (p < 0.05). In conclusion, the application of ozone does not impair the composite-to-composite bond.

Effect of post-cure heating on the flexural strength of two indirect resin composites.

The aim of this study was to evaluate whether a post-cure heat-treatment may improve the flexural strength of two indirect resin-based composites. Tested factors were: material (Gradia Indirect, Gradia Forte), mass (opaqus dentin, dentin, enamel) and curing mode (light, light and heat). A three-point bending test appliance was developed according to ISO 4049/2000. Three-Way ANOVA and 2-Pameter Weibull cumulative distribution function were performed. Factors material and curing mode were significant (p < 0.001), while the mass type was not (p = 0.181). A post-cure heat treatment may be useful for enhancing the flexural strength of both materials.

Morphological analysis of three zirconium oxide ceramics: Effect of surface treatments.

OBJECTIVE: To evaluate the effect of different chemo-mechanical surface treatments on the morphology of three recently marketed dental zirconia ceramics. MATERIALS AND METHODS: Ceramic discs (Ø 10 mm x 1 mm height) were obtained from three sintered zirconia ceramics (Lava, Cercon, and Aadva Zr) and treated with: (1) airborne particle abrasion with 125 microm Al(2)O(3) particles (S); (2) selective infiltration etching (SIE); (3) experimental hot etching solution applied for 30 min (ST); (4) no treatment (C). Five discs per group were used for surface roughness analysis using an atomic force microscope (AFM). Data were statistically analyzed by Kruskall-Wallis analysis of variance and Mann-Whitney tests (alpha<0.05). The same discs were evaluated under SEM for surface topography analysis. Three discs per group were cemented to a composite overlay (Paradigm MZ100) with a total-etch resin luting agent (Calibra) and cross-section interfacial analysis was performed under SEM. RESULTS AND SIGNIFICANCE: Airborne particle abrasion improved the average surface roughness of Cercon and Lava (p<0.05) while SIE induced significant changes on Lava and Adava Zr. Statistical differences in surface roughness were recorded after selective infiltration etching when compared to no treated group, independently from the zirconia type. SEM and AFM analyses revealed changes in surface topography for all the tested ceramics and intergrain spaces opening, especially after ST. The effectiveness of the tested chemo-mechanical surface treatments depends on the zirconia type. The hot experimental etching solution increased the surface roughness of all the tested ceramics creating retentive micro-spaces that may potentially improve zirconia/resin cement interfacial strengths.

Influence of ozone application on the repair strength of silorane-based and ormocer-based composites.

PURPOSE: To evaluate the effect of gasiform ozone on the repair strength of ormocer-based and silorane-based composites. METHODS: 160 cavities were created in methacrylate cylinders. Half of the cavities were filled with a silorane-based composite, whereas the other half was filled with an ormocer-based composite. After storage (1 week, deionized water, 37 degrees C) the specimens of each restorative material were divided into two main experimental groups: in Group 1 the specimens were subjected to a 60-second ozone gas application; in Group 2 no pretreatment was performed (control). The corresponding adhesive of each restorative material was applied as the intermediate repair agent in both groups. Repair cylinders were then built up with the homologous material. Half of the specimens in each group were subjected to thermocycling (5,000 cycles, 5 degrees C-55 degrees C, dwell time 30 seconds, transfer time 5 seconds) prior to testing, whereas the other specimens were immediately tested. The repair strength was assessed with a shear test. The two-way ANOVA with pretreatment and thermocycling as the main factors was used to analyze the shear bond strength data within each restorative material. RESULTS: The pretreatment, the thermocycling and their interaction did not significantly affect the repair strength of either tested materials (P > 0.05). The ozone treatment did not significantly affect the repair strength. The silorane-based composite showed lower repair strengths compared to those of the ormocer-based composite. The immediate repair strengths in the ozone-treated and control groups were respectively, 28.1 (13.8) MPa and 28.8 (8.8) MPa for the silorane-based composite and 31.5 (9.3) MPa and 35.6 (10.6) MPa for the ormocer-based composite. After thermocycling, the repair strengths in the ozone-treated and control groups were 27.7 (9.7) MPa and 29.5 (11.1 ) MPa for the silorane-based composite and 31.4 (6.0) MPa and 34.2 (4.5) MPa for the ormocer-based composite. Mixed failures occurred most frequently in all experimental groups. In conclusion, ozone did not affect the repair strength of the tested silorane-based and ormocer-based composites.

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

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

In vitro evaluation of bonding effectiveness to dentin of all-in-one adhesives.

OBJECTIVES: The study was aimed at assessing the bonding potential of all-in-one adhesives to dentin. METHODS: The microtensile bond strength of the all-in-one adhesives Bond Force (Tokuyama), AdheSE One (Ivoclar-Vivadent), and Xeno V (Dentsply) was measured in comparison with the etch-and-rinse system XP Bond (Dentsply). The ultrastructural characteristics of dentin-adhesive interface were observed under scanning electron microscope (SEM). Twenty human extracted third molars had their mid-coronal dentin exposed and ground with wet 600-grit SiC paper in order to create a standardized smear layer. Bonding procedures were performed according to the manufacturers' instructions and microtensile beams were obtained with the "non-trimming" technique. The bond strengths in MPa were statistically analyzed including pre-test failures as "zero" values (Kolmogorov-Smirnov test, Levene's test, One-Way ANOVA, Tukey's test p<0.05). RESULTS: The following bond strengths were recorded in MPa (mean+/-standard deviation): AdheSE One 31.7+/-21.3; Xeno V 42.8+/-26.4; Bond Force 43.3+/-22.1; XP Bond 51.9+/-18.6. The statistical analysis demonstrated that the bond strengths achieved by Bond Force and Xeno V were similar to that of the etch-and-rinse adhesive, whereas the bond strength of AdheSE One was significantly lower. A distinct hybrid layer with resin tags was seen only in XP Bond specimens. All-in-one adhesives demonstrated a rather superficial interaction with the dentin substrate. CONCLUSIONS: Although the strongest bond to dentin was established by the etch-and-rinse system, however the all-in-one adhesives containing organic solvents reached bond strength levels that were comparable from a statistical point of view.

Repair potential of a laboratory-processed nano-hybrid resin composite.

The purpose of this study was to compare the 24-h composite-to-composite microtensile bond strength of Gradia Forte (GF) repaired with the same or a different material after different surface treatments. Different groups were set up, in which composite blocks of GF were subjected to the following treatments: Group 1, sandblasting with 50-microm aluminum oxide and 37% phosphoric acid etching (PA); Group 2, bur roughening and etching with 37% PA; Group 3, etching with 37% PA only. In all groups, a bonding resin was used as an intermediate agent prior to layering of the repair material (Gradia Direct (GD), Gradia (G), or GF). Bond strengths were then determined and analysed statistically. Scanning electron microscopy (SEM) evaluation of substrates and bonded interfaces was also performed. Surface treatment (P < 0.001) and repair materials (P < 0.001) were factors that significantly affected repair strength, whereas their interaction (P = 0.31) had no significant effect. Group 3 showed significantly superior repair strength to Groups 1 and 2, whereas Group 2 showed significantly weaker repair strength to Groups 1 and 3. Irrespective of surface treatment, GD and G gave similar results, which were better than those obtained using GF. The lowest probability of failure was found for GD and G in Group 3, whereas the highest was found for GF in Groups 1 and 2. Premature failures occurred mainly with G and GF. No pre-testing failures were found in the sandblasting/GD subgroup. Surface-treated composites showed different textures under SEM, whereas composite-repair bonds showed comparable interfacial features.

Flowable composites as intermediate agents without adhesive application in resin composite repair.

PURPOSE: To evaluate the effect of different intermediate resin agents on composite-to-composite microtensile bond strength (microTBS). METHODS: Composite disks (8 x 4 mm) of Gradia Direct Anterior (N = 15) and Filtek Supreme XT (N = 15), stored in a saline solution at 37 degrees C for 1 month, were sandblasted (Microetcher, 50 microm-Al2O3), cleaned (35% H3PO4), and randomly divided into five groups (N = 3) according to the intermediate agent applied. Two flowable composites (Gradia LoFlo; Filtek Supreme XT Flow) and two adhesives (Adper Scotchbond 1XT, Scotchbond Multi-Purpose) were used. As a control, no intermediate agent was applied. Each disk was incrementally repaired (8x8 mm) with the same resin as the respective substrate. By serially cutting each repaired specimen, multiple sticks of about 0.8 mm2 in cross-section were obtained and loaded in tension until failure at a cross-head speed of 0.5 mm/minute. Data were statistically analyzed. Failure mode was examined by stereo- and scanning electron-microscopy (SEM). Additional specimens were prepared to morphologically evaluate the composite-to-composite interfacial quality by SEM analysis. RESULTS: Composite substrate and intermediate agent were significant factors (Two-way ANOVA, P < 0.001). Bond strengths achieved with Gradia Direct Anterior were higher than Filtek Supreme XT. The application of flowable composites resulted in statistically superior microTBS than adhesives and control (Tukey test, P < 0.001). Failure mode was predominantly cohesive (flowable composites), cohesive/adhesive (adhesives) and adhesive (no treatment). Flowable composites and adhesives showed a good interfacial quality.

Effect of pre-cure temperature on the bonding potential of self-etch and self-adhesive resin cements.

OBJECTIVES: To assess whether the pre-cure temperature of resin cements significantly influenced the bonding potential to dentin. METHODS: Forty extracted molars were randomly divided into 8 groups (n=5): Groups (1-4) RelyX Unicem (RU, 3 M ESPE) and Groups (5-8) Panavia F 2.0 (PF, Kuraray Co.), at pre-cure temperatures of 4, 24, 37, and 60 degrees C, respectively. Cements were used in dual-cure mode for luting composite overlays (Paradigm MZ100, 3 M ESPE) to dentin. Microtensile bond strength testing and scanning electron microscope (SEM) observations of cement-dentin interfaces were performed. RESULTS: Group 4 had to be eliminated as RU at 60 degrees C underwent such an accelerated curing that was already set at the time of dispensing. The bond strengths (MPa) measured at refrigerator, room, and intraoral temperature were, respectively: RU 5.4+/-1.7, 11.4+/-6.1, 10.6+/-4.2; PF 7.4+/-3.7, 13.9+/-6.2, 12+/-5.2. The statistical analysis revealed that both luting agents developed a significantly weaker adhesion when used at refrigerator temperature (p<0.05). No statistically significant differences in bond strength were recorded when either cement was used at 24 or 37 degrees C (p>0.05). Pre-heating of PF to 60 degrees C resulted in a significant increase in bond strength (20.7+/-9.4 MPa; p<0.05). SEM observations disclosed an enhanced potential of PF to form a hybrid layer as the temperature increased over 4 degrees C. RU exhibited a less porous and more homogeneous layer at intraoral than at refrigerated temperature. SIGNIFICANCE: It is advisable to let refrigerator-stored resin cements warm up to at least room temperature prior to clinical use. Pre-heating to 60 degrees C enhances the bonding potential of PF.

Hydrolytic stability of composite repair bond.

The hydrolytic stability of composite repairs is a desirable property. In the present study, the composite repair microtensile bond strength, failure mode distribution, and nanoleakage occurrence before and after thermocycling were evaluated. Standardized, 1-month-old composite substrates were roughened, cleaned, and randomly assigned to seven groups according to the intermediate agent applied. Resin-based, silane-based, and combined silane/adhesive coupling agents were investigated. The same resin composite as the substrate was used for repair. For each group, repaired samples were wet stored for 24 h (37 degrees C) or thermocycled (5,000 cycles, 5-55 degrees C). Failure mode and silver nitrate penetration were examined by stereomicroscopy. Intermediate agent, experimental condition, and their interaction were significant factors. Hydrophobic flowable composites resulted in statistically higher repair strengths, lower occurrence of adhesive failures, and good quality interfacial coupling without any silver uptake in both conditions. Light-curing, hydrophilic resin monomer-based intermediate agents, although not affected by thermocycling, showed a more pronounced silver penetration. The composite repair strength of a self-curing silane/adhesive agent was significantly affected by thermal stresses, despite the absence of silver uptake. A prehydrolized silane agent recorded the lowest repair strength, with minimal or no evidence of interfacial silver impregnation after thermocycling. In conclusion, flowability and hydrophobic nature can be considered important properties when selecting intermediate agents for composite repair.

Effect of air-drying temperature on the effectiveness of silane primers and coupling blends in the repair of a microhybrid resin composite.

PURPOSE: To evaluate the effect of different silane agents and air-drying temperatures on the repair strength of a microfilled hybrid composite. MATERIALS AND METHODS: Composite cylinders (8 x 4 mm) of Gradia Direct Anterior (GC, N=36), stored in a saline solution at 37 degrees C for 1 month, were sandblasted (50-microm aluminium oxide), cleaned (35% phosphoric acid) and randomly divided into six groups (n=6). Two prehydrolyzed silane primers (Monobond-S, Ivoclar-Vivadent, Porcelain Primer, Bisco), a non prehydrolyzed silane primer (Porcelain Liner M, Sun Medical) and three silane/adhesive coupling agents (Porcelain Bond Activator-PBA/Clearfil New Bond, PBA/Clearfil SE Bond, PBA/Clearfil Tri-S Bond, Kuraray) were investigated. Silane-coated surfaces were air dried at two different temperatures (23 degrees C and 38 degrees C) and repairs (8 x 8 mm) were fabricated (Gradia Direct Anterior). Unrepaired composite cylinders (8 x 8 mm, n=6) were used as control to evaluate the cohesive strength of the material. Microtensile bond strength measurements (microTBS) were performed. RESULTS: The silane agent applied (p < 0.001), the airdrying temperature (p < 0.001) and their interaction (p < 0.001) were significant factors (two-way ANOVA, Tukey test; p < 0.05). Silane primers achieved inferior microTBS when air dried at 23 degrees C as compared to silane/adhesive blends. Warm air-drying was significantly beneficial to composite repairs mediated by silane primers. Comparable results were achieved by silane/adhesive couplings at 23 degrees C and 38 degrees C. At 38 degrees C all the intermediate agents resulted in repair microTBS that were comparable to the 24-h cohesive strength of the composite (one-way ANOVA, Dunnett t-tests; p < 0.05). CONCLUSION: The chemical interactions between silane primers and compozite substrate may be optimized through warm airdrying. Silane/adhesive couplings were not influenced by the air drying temperature.

Effect of intermediate agents and pre-heating of repairing resin on composite-repair bonds.

This study investigated the composite-to-composite microtensile bond strength and interfacial quality after using different combinations of intermediate agents and pre-curing temperatures of repairing resin. Forty-five composite discs (8x4 mm) of Gradia Direct Anterior (GC Corp), stored in a saline solution at 37 degrees C for one month, were sandblasted (50 microm aluminum oxide), cleaned (35% phosphoric acid) and randomly divided into three groups (n=15) according to the intermediate agent applied: (1) no treatment; (2) unfilled resin (Scotchbond Multi-Purpose Adhesive, 3M ESPE); (3) flowable composite (Gradia LoFlo, GC Corp). Each disc was incrementally repaired (8x8 mm) with the same resin as the substrate. For each group, three subgroups (n=5) were created, depending on the pre-curing temperature of the repairing resin-4 degrees C, 23 degrees C or 37 degrees C. Two bonded specimens per group were prepared to evaluate the composite-to-composite interfacial quality via scanning electron microscope. Microtensile bond strength measurements were performed with the remaining three specimens and failure mode was examined by stereomicroscopy. Two-way ANOVA revealed that temperature (p < 0.001), intermediate agent (p < 0.001) and the interaction (p = 0.002) significantly affected the repair strength. Post-hoc comparisons revealed that bond strengths were significantly lower using a 4 degrees C repairing resin in groups where intermediate agents were used. The highest bond strengths were recorded when flowable composite was used as an intermediate agent under each of the three temperature conditions. Interfacial quality improved by raising the resin temperature from 4 degrees C to 37 degrees C.