Impact of try-in paste removal on the fatigue behavior of bonded lithium disilicate ceramics

Abstract

This in vitro study assessed the effectiveness of three cleaning protocols (air-water spray, 37% phosphoric acid, or Ivoclean) on lithium disilicate restorations' fatigue behavior after try-in paste application, compared to a clean condition. Lithium disilicate discs (IPS e.max CAD, Ivoclar) with Ø-= 12 mm and 1 mm thickness were prepared from prefabricated CAD-CAM blocks, polished, subjected to CAD-CAM milling topography simulation and crystallization. After, etching with 5% hydrofluoric acid and the application of try-in paste (Variolink try-in paste shade white; load of 2.5 N for 5 min) was performed. Discs that received try-in paste were divided into three groups according to the removal protocol: SPRAY – air-water spray for 30 s; HPO – active application of 37% phosphoric acid for 60 s; IVOC – application of Ivoclean for 20 s. Control group (CTRL group) did not receive the try-in paste application. Half of the specimens (n= 15) were tested in the baseline condition (24 h up to 7 days), and the others underwent 25,000 thermal cycles (5 – 55 °C) + 210 days of distilled water storage (37 °C). Additional specimens (n= 3) underwent monotonic testing (1 mm/min). Fatigue testing involved a cyclic fatigue approach (20 Hz, initial load = 100 N – 5000 cycles, step size = 50 N – 10,000 cycles) until a visible crack appeared. Fractographic and topographic analyses were performed. Fatigue data were statistically analyzed with two-way ANOVA, Kaplan-Meier log-rank (Mantel-Cox), and independent t-test (α= 0.05). In the baseline condition, the IVOC group resulted in a superior fatigue behavior compared to the CTRL and SPRAY groups, but similar to the HPO group. The HPO and SPRAY presented a similar fatigue behavior to the CTRL group. It was noticed a decrease in fatigue behavior after aging, which resulted in all the cleaning protocols leading to similar fatigue behavior compared to the CTRL group. On the SPRAY group surface, try-in pastes remnants were noticed. In summary, despite a detrimental impact at baseline conditions, all tested cleaning protocols seem proper to remove the try-in paste from the ceramic's surface in the long-term evaluation.