The effect of surface conditioning techniques on the shear bond strength of zirconia-reinforced lithium silicate ceramic following adhesive cementation - An in vitro study.

Aim: The aim of this study was to determine the effect of different surface conditioning techniques on the bond strength between zirconia-reinforced lithium silicate (ZLS) ceramics and resin cement. Materials and Methods: Fifty samples of ZLS ceramic were used and allotted into five groups with 10 samples per group based on the type of surface conditioning technique. The ceramic specimens were crystallized and embedded into acrylic resin. The five groups were group 1 (negative control-without surface treatment); group 2 (10% hydrofluoric [HF] acid + silanization); group 3 (10% HF acid only); group 4 (self-etching ceramic primer [SECP]); and group 5 (experimental laboratory sealing of the conditioned surface). Resin cylinders were bonded using self-adhesive resin cement and were subjected to thermocycling after 24 h storage. The shear bond strength was tested with a universal testing machine. Statistical Analysis Used: One-way ANOVA was used for comparing five groups (P < 0.05 was considered significant). Results: Group 4 showed the highest mean bond strength value (23.4 MPa ± 2.21 MPa). A statistically significant difference was noted between group 4 and all the other groups tested in the study (P < 0.05). Conclusion: It can be concluded that the SECP can be considered an alternative to the conventional protocol of HF acid and silane application for the surface conditioning of ZLS ceramic.

Influence of surface treatments and adhesive protocols on repair bond strength of glass-matrix and resin-matrix CAD/CAM ceramics.

OBJECTIVE: To specify the effects of self-etching ceramic primer, Monobond Etch and Prime (MEP), and universal adhesive (UA) on repair bond strength between CAD/CAM blocks and resin composite. MATERIALS AND METHODS: Vita Mark II (VM), IPS e.max CAD (EMAX), Shofu Block HC (SHC), and Tetric CAD (TET) blocks were sliced and thermocycled. They were divided into four groups according to surface treatments (n = 24): control, sandblasting (AL), hydrofluoric acid etching (HF), and MEP application. SEM analysis assessed surface topography. Subdivided, specimens followed distinct adhesive protocols (n = 12): control (silane + adhesive [SA] or adhesive [A] only for MEP group) and UA. Microshear bond strength (µSBS) was measured following resin composite repair. Data were analyzed using two-way ANOVA and Tukey tests (p < 0.05). RESULTS: The µSBS of CAD/CAM blocks was significantly influenced by surface treatment type and adhesive protocol. The highest µSBS values for each block, considering surface treatment + adhesive protocol, were VM, HF + SA, or HF + UA; EMAX, MEP + A; and SHC and TET, AL + SA, or AL + UA. CONCLUSIONS: Except for EMAX, it was not the adhesive protocol that made the significant difference in bond strength for each CAD/CAM block, but the surface treatment. MEP + UA application on glass ceramics lowered µSBS values significantly, so it is not recommended in clinical conditions. CLINICAL SIGNIFICANCE: Repair is an essential therapeutic option, particularly in esthetic restorations, to swiftly repair the impaired esthetics caused by fracture. Repair protocol is dependent on the restorative material, and to have a reliable repair bond strength, the following surface treatment and adhesive protocol combinations are recommended for each CAD/CAM block: VM, HF + SA, or HF + UA; EMAX, MEP + A; and SHC and TET, AL + SA, or AL + UA.

Adhesive Performance of Resin Cement to Glass-Ceramic and Polymer-Based Ceramic CAD/CAM Materials after Applying Self-Etching Ceramic Primer or Different Surface Treatments.

Ensuring optimum bond strength during cementation is vital for restoration success, with the practicality of the process being crucial in clinical practice. This study analyzed the effect of a single-step self-etching ceramic primer (MEP) and various surface treatments on the microshear bond strength (µSBS) between resin cement and glass-ceramic or polymer-based ceramic CAD/CAM materials. Specimens were fabricated from leucite-based glass-ceramic (LEU), lithium disilicate glass-ceramic (LDC), resin nanoceramic (RNC), and polymer infiltrated ceramic network (PICN) (n = 160). They were then classified based on the surface treatments (n = 10): control (no treatment); sandblasting with Al2O3 (AL); etching with hydrofluoric acid (HF); and MEP application. Scanning electron microscopy was used to evaluate the surface topography. µSBS was measured after cementation and thermocycling procedures. Failure modes were examined with a stereomicroscope. Statistical analysis involved two-way analysis of variance and Tukey HSD tests with a significance level of 0.05. µSBS was significantly influenced by both surface treatment and CAD/CAM material type. The most enhanced µSBS values for each material, regarding the surface treatment, were: LEU and LDC, HF; RNC, AL; PICN, AL or HF. MEP significantly increased the µSBS values of CAD/CAM materials except RNC, yet it did not yield the highest µSBS values for any of them.

Polifluoruro de amonio como alternativa de acondicionamiento para laminados ultradelgados de disilicato de litio. Reporte de caso / Ammonium polyfluoride as an alternative for the surface conditioning of ultrathin lithium disilicate veneers. A case report

RESUMEN: Los laminados vitrocerámicos ultradelgados constituyen una alternativa conservadora para la resolución de alteraciones estéticas. Sin embargo, su acondicionamiento con ácido fluorhídrico suele no estar exento de complicaciones, por lo que el uso de un sistema autograbante en base a polifluoruro de amonio (Monobond Etch&Prime, MEP) permite disminuir el riesgo de sobregrabado, simplificando la técnica. El presente reporte presenta el seguimiento a dieciocho meses de un caso clínico resuelto mediante laminados vitrocerámicos acondicionados únicamente con MEP. Caso. Paciente joven con alteraciones estéticas en el sector anterosuperior. Se realizaron preparaciones conservadoras para la confección de laminados ultradelgados en disilicato de litio (e.maxPress). Las vitrocerámicas fueron acondicionadas sólo con MEP y se cementaron con Variolink Esthetic LC. Al año y medio las restauraciones se observaron indemnes, manteniendo un buen ajuste marginal y ausencia de tinciones. Conclusiones. MEP aparece como una alternativa prometedora para reemplazar al ácido fluorhídrico en la cementación de laminados vitrocerámicos.

ABSTRACT: Ultrathin glass-ceramic veneers are a conservative approach for the restorative treatment of aesthetic disorders in the anterior region. However, surface conditioning with hydrofluoric acid of the thin structures can be usually a challenging step. Therefore, the use of a self-etching ceramic primer containing ammonium polyfluoride (Monobond Etch&Prime, MEP) offers a simplified technique with a reduced risk of overetching. Here we present an 18-month follow-up of ultrathin glass-ceramic veneers conditioned with MEP only. Case. Young female patient with an aesthetic disorder in the front region. The four upper incisors were conservatively prepared for ultrathin lithium disilicate (e.maxPress) veneers. Pre-treatment of the glass-ceramics consisted only of MEP application, followed by adhesive cementation with Variolink Esthetic LC. At the 1.5-year recall, the restorations appeared undamaged, with no marginal gap or staining. Conclusions. MEP constitutes a promising alternative to hydrofluoric acid for the adhesive cementation of glass-ceramic veneers.

Bond Strength of CAD/CAM Restorative Materials Treated with Different Surface Etching Protocols.

PURPOSE: To evaluate the effect of different surface treatments on the surface morphology of CAD/CAM ceramics and on their bond strength to cement. MATERIALS AND METHODS: Sixty cubic sections were cut from each of three materials (lithium disilicate glass-ceramic [DL], leucite-based glass-ceramic [LC], resin-matrix ceramic composite [RMCC]) and were treated as follows (n = 10): 1. no treatment (C); 2. 5% hydrofluoric acid applied for 20 s plus silane (HF5% 20 s); 3. 5% hydrofluoric acid applied for 60 s plus silane (HF5% 60 s); 4. 10% hydrofluoric acid applied for 20 s plus silane (HF10% 20 s); 5. 10% hydrofluoric acid applied for 60 s plus silane (HF10% 60 s); 6. Self-etching ceramic primer (MBEP). Ceramic cubes were bonded to pre-polymerized composite resin cubes with a composite cement. Each set was cut into stick-shaped specimens (1 ± 0.3 mm2). After 24-h water storage, microtensile bond strength (µTBS) was measured. Data were analyzed using two-way ANOVA and Tukey's test (α = 0.05). Failure pattern and surface morphology were assessed using scanning electron microscopy (SEM). RESULTS: Both factors significantly influenced µTBS, while no interaction between factors was found. RMCC presented statistically higher µTBS values than LC and DL, while the surface treatments HF5% 20 s, HF5% 60 s, HF10% 20 s, HF10% 60 s and MBEP, did not show statistical differences between them, although they resulted in statistically significantly higher bond strengths than did C groups. A high number of pre-test failures were detected in the control groups for all materials. MBEP produced less extensive surface alterations than did all HF treatments. CONCLUSION: All of the hydrofluoric acid treatments tested showed similar cement-ceramic bonding efficacy. The self-etching ceramic primer produced less surface alterations and comparable bonding efficacy compared to separate hydrofluoric acid/silane primer application.

Do Different Application Modes Improve the Bonding Performance of Self-etching Ceramic Primer to Lithium Disilicate and Feldspathic Ceramics?

PURPOSE: To evaluate the effect of different application modes of a recently introduced self-etching ceramic primer on the microshear bond strength (µSBS) and ceramic surface-etching pattern of two glass-ceramic surfaces. MATERIALS AND METHODS: Twenty-two CAD/CAM blocks of lithium disilicate (LD) and feldspathic glass ceramic (VTR) were each cut into 4 rectangular sections (n = 88 for ceramic surface). The LD and VTR specimens were divided into one control group (hydrofluoric acid + silane coupling agent [HF+SII]), and 10 experimental groups using Monobond Etch and Prime (MEP) applied for a combination of scrubbing times (5, 10, 20, 40, and 60 s) and reaction times (20 or 40 s). After each treatment, Tygon matrices (n = 8) were filled with a resin cement and light cured for each ceramic specimen. The specimens were stored in water at 37°C for 24 h and subjected to the µSBS test. The failure pattern and µSBS were statistically evaluated (α = 0.05). In addition, the ceramic surface etching pattern was analyzed using scanning electron microscopy. RESULTS: For the LD groups, the application of MEP 60/40 resulted in a higher mean µSBS compared to HF+SI (p < 0.05). Groups 5/40, 10/40, and 20/40 resulted in mean µSBS similar to that obtained by HF+SI (p > 0.05). For VTR, no significant difference was observed among the groups (p = 0.32). Compared with MEP, HF better promoted the dissolution of glass matrix for both ceramics. However, prolonged MEP scrubbing or reaction caused significant dissolution of the glass matrix for both evaluated ceramics. CONCLUSION: Active and prolonged application of MEP may be a viable alternative to HF+SI for increasing the bond strength to LD.

Physicochemical and morphological characterization of a glass ceramic treated with different ceramic primers and post-silanization protocols.

OBJECTIVE: Evaluate the effect of different ceramic primers and post-silanization protocols on physicochemical and morphological characteristics of a lithium disilicate glass ceramic. METHODS: Lithium disilicate ceramic (IPS e-max CAD) plaques (6 × 10 × 2 mm) were divided into 3 groups according to the ceramic primer used: (1) Silane (RelyX Ceramic Primer-RL); (2) Silane + MDP (Clearfil Ceramic Primer Plus-CP); (3) Self-etching ceramic primer (Monobond Etch and Prime-MB). Specimens from each group were distributed into 5 sub-groups according to post-silanization protocols: (a) Treated as recommended by the manufacturer (MR), (b) MR + Additional drying with air at room temperature for 30 s (RTA), (c) MR + additional drying with hot air for 30 s (HT), (d) MR + Surface rinsing with water at room temperature for 10 s and drying with air at room temperature for 30 s (WT), and (e) Specimens were not silanized (NS). Surface free energy (SFE) was determined using static contact angles measurements with water and diiodomethane. SFE data were submitted to Friedman followed by Wilcoxon post-hoc test (α = 0.05). Morphology was analyzed using scanning electron microscopy. Elemental composition and chemical interactions were determined with X-ray photoelectron spectroscopy analysis. RESULTS: RL presented the highest SFE (62.4 mN/m) followed by CP (59.7 mN/m). Post-silanization protocols resulted in similar SFE, but WT and HT induced the highest water contact angles when using CP and RL. CP modified ceramics' surface morphology compared to the etched and RL treated groups. The presence of water was identified on CP treated specimen. All analyzed primers formed siloxane bonds with ceramic surface. SIGNIFICANCE: Ceramic primers resulted in different surface free energy and morphology, but siloxane bonds were identified for all tested solutions. HT and WT protocols should be used with RL and CP primers. MB was not influenced by the different silanization protocols.

Comparison of Self-Etching Ceramic Primer and Conventional Silanization to Bond Strength in Cementation of Fiber Reinforced Composite Post.

Various mechanical and chemical surface treatments have been proposed to improve the retention of fiber-reinforced composite post (FRCP), but the results are still controversial. The bond strength and durability of a self-etching ceramic primer, which was recently released as an alternative to etching and silane, are not yet known. This study aimed to compare and evaluate the push-out bond strength of different surface treatments of FRCPs after an artificial aging procedure. Four groups (n = 10) were established to evaluated FRCP surface treatments (dentin adhesive bonding; silane and adhesive bonding; hydrofluoric acid, silane and adhesive bonding; and a self-etching ceramic primer). They were bonded with dual-curing rein cement (Multilink N) and stored in distilled water at 37 °C for 30 days, then thermal cycled for 7500 cycles. After being sectioned into 1 mm thickness, each coronal and apical part was evaluated for its the push-out bond strength by a universal testing machine. Each debonded specimen was observed by an optical microscope and divided according to the failure modes. The results showed that silane treatment significantly improved push-out bond strength, but the self-etching ceramic primer did not do so. Additional hydrofluoric acid treatment or the adhesive bonding agent alone did not significantly improve the retention of FRCPs. Cohesive failure of the luting material was found most frequently in all groups.

Effect of acid etching on tridimensional microstructure of etchable CAD/CAM materials.

OBJECTIVE: Evaluate if etching protocols affect superficial/internal microstructural integrity of CAD/CAM ceramic materials. METHODS: Sixty blocks (3×3×3mm) of IPS/Empress-LEU, IPS/e.max-LDC (Ivoclar-Vivadent) and Enamic-PIC (VITA) were used. Lateral surfaces from each block were isolated with Teflon strip and petroleum jelly to keep them untouched. Specimens were distributed into 6 groups (n=10): 1. no treatment (C); 2. hydrofluoric acid (HF) 5%, 20s (HF5%20s); 3. HF5%60s; 4. HF10%20s; 5. HF10%60s; 6. Monobond Etch&Prime (MBEP). Surface roughness (Sa) and 3D profile were obtained using a confocal-laser-optical-microscope (LEXT OLS 4000, Olympus), while element ratios (Si/K for LEU and LDC; Si/C for PIC) were recorded using energy dispersive spectroscopy (EDS). Superior (treated) and lateral (non-treated) surfaces were analyzed using scanning electron microscopy (SEM) (JSM 5600 LV, JEOL). Etching depth was measured on lateral surfaces. Data were submitted to ANOVA-One-Way and Tukey test (α=0.05). RESULTS: For LEU, only HF10% treatments produced statistically different roughness values and Si/K ratios compared to C group. Regarding LDC and PIC, groups HF5%60s and HF10% showed higher roughness values than C group. In the case of PIC, all treatments (except MBEP) produced lower Si/C ratios than C group. All treatments (except MBEP) produced higher etching depth values than C group for all materials, being HF10%60s the highest (LEU:403.2±11.4µm; LDC:617.4±75.7; PIC:291.6±6.5µm). HF10% produced more aggressive etching morphology patterns on superior and lateral surfaces (SEM). Treatments MBEP and HF5%20s, produced the least aggressive structural alterations. Acid etching produces superficial and internal alterations on ceramics' structural configuration. SIGNIFICANCE: Aggressive etching protocols of glass-ceramics may cause internal material loss, consequently, milder etching is recommended to treat those materials before adhesion procedures.

Self-etching ceramic primer versus hydrofluoric acid etching: Etching efficacy and bonding performance.

AIM: This study assessed the effect of pretreatment of hybrid and glass ceramics using a self-etching primer on the shear bond strength (SBS) and surface topography, in comparison to pretreatment with hydrofluoric acid and silane. METHODS: 40 rectangular discs from each ceramic material (IPS e.max CAD;EM, Vita Mark II;VM, Vita Enamic;VE), were equally divided (n=10) and assigned to one of four surface pretreatment methods; etching with 4.8% hydrofluoric acid followed by Monobond plus (HFMP), Monobond etch & prime (Ivoclar Vivadent) (MEP), No treatment (NT) as negative control and Monobond plus (Ivoclar Vivadent) with no etching (MP) as positive control. SBS of resin cement (Multilink-N, Ivoclar Vivadent) to ceramic surfaces was tested following a standard protocol. Surface roughness was evaluated using an Atomic force microscope (AFM). Surface topography and elemental analysis were analyzed using SEM/EDX. Data were analyzed with two-way analysis of variance (ANOVA) and post-hoc Bonferroni test at a significance level of α=0.05. RESULTS: Pretreatment with HFMP resulted in higher SBS and increased surface roughness in comparison to MEP and MP. Regardless the method of surface pretreatment, the mean SBS values of EM ceramic was significantly higher (p<0.05) than those recorded for VM and VE, except when VE was treated with MEP, where the difference was statistically insignificant. Traces of fluoride ion were detected when MEP was used with VE and VM. CONCLUSION: Under limited conditions, using MEP resulted in comparable SBS results to HFMP; meanwhile HFMP remains the gold standard for pretreatment of glass ceramics for resin-luting cementation.