Multilink Primer Research Articles

Influence of thermomechanical fatigue on the fracture strength of CAD-CAM-fabricated occlusal veneers

Statement of problemWith the development of new computer-aided design and computer-aided manufacturing (CAD-CAM) restorative dental materials, limited data regarding their survival rate and fracture strength are available when they are used as occlusal veneers. Therefore, these materials should be evaluated under conditions similar to those of the oral environment before being recommended for clinical use. PurposeTo evaluate the influence of thermomechanical fatigue loading on the fracture strength of minimally invasive occlusal veneer restorations fabricated from different CAD-CAM materials and bonded to human maxillary premolars using self-etchnig bonding technique. Material and methodsSixty-four CAD-CAM occlusal veneer restorations were fabricated from group LD (lithium disilicate [e.max CAD]), LS (zirconia-reinforced lithium silicate [Vita Suprinity]), PI (polymer-infiltrated ceramic [Vita Enamic]), and PM (polymethylmethacrylate [Telio CAD]). The occlusal veneers were luted to enamel (n=16) using a self-etching primer (Multilink Primer A/B) and a luting composite resin (Multilink Automix). Half of the specimens of each group (n=8) were randomly selected and subjected to thermomechanical fatigue loading in a masticatory simulator (1.2 million cycles at 98 N with 5°C-55°C thermocycling). All specimens were quasistatically loaded until fracture. The statistical analysis was made using the Kruskal-Wallis and Mann-Whitney U tests (α=.05). ResultsAccording to the Kaplan-Meier analysis after the thermomechanical fatigue of the 4 groups, the cumulative survival rate was as follows: group LD, 50% group LS, 62.5% group PI, 37.5%; and group PM, 50%. Although some of the surviving specimens exhibited microcracking, their integrity or bonding to teeth was not affected. Thermomechanical fatigue significantly reduced the fracture strength of group PI (P=.047) and group PM (P=.025). Without thermomechanical fatigue, group PM showed significantly higher fracture strength than group LS (P=.015). ConclusionsIn general, thermomechanical fatigue decreased the survival rate and fracture strength in all test groups.

Fatigue Failure Load of Resin-bonded Simplified Lithium Disilicate Glass-Ceramic Restorations: Effect of Ceramic Conditioning Methods.

To evaluate the influence of different ceramic surface conditioning methods on the fatigue failure load of adhesively cemented simplified lithium-disilicate glass-ceramic restorations. Ceramic (IPS e.max CAD, Ivoclar Vivadent) (Ø = 10 mm; thickness = 1.2 mm) and epoxy resin (Ø = 10 mm; thickness = 2.3 mm) disks were produced. The ceramic bonding surfaces were treated as follows: no etching and MPS-silane primer application only (MN); etching with 10% hydrofluoric acid (HF) for 20 s followed by primer application (HF + MN); HF + universal multimode adhesive application (HF + SU); etching with a one-step etching primer (ME&P); HF + primer + conventional adhesive (HF + MN + PAB). The epoxy resin disks were etched with 10% HF for 20 s followed by a coat of bonding agent (Multilink Primer A+B). Pairs of ceramic/epoxy resin disks were cemented with composite cement (Multilink N, Ivoclar Vivadent). The mean fatigue failure load was determined by the staircase method (100,000 cycles at 20 Hz frequency; initial load = 1435 N; step size = 72 N). ME&P had the highest fatigue failure load, followed by HF etched groups, while the non-etched condition (MN group) had the lowest. All samples presented radial cracks originating from defects at the conditioned ceramic surface (interface). The simultaneous physicochemical conditioning with one-step self-etching ceramic primer promoted the best fatigue behavior results of the glass-ceramic restorations. It might indicate that this one-step conditioning reduces the number of flaws at the ceramic surface due to the slighter surface alterations than those produced by hydrofluoric acid etching, improving the fatigue behavior.

The effect of hydrofluoric acid concentration on the fatigue failure load of adhesively cemented feldspathic ceramic discs

ObjectiveThis study investigated the influence of hydrofluoric acid (HF) etching at different concentrations on the fatigue failure load of adhesively cemented feldspathic ceramic discs (Vita Mark II). Besides, their effect on the micromorphology of ceramic surface was investigated. MethodsEighty ceramic discs (ϕ=10 mm; thickness=1.5 mm) were cemented to epoxy supporting discs (ϕ=10 mm; thickness=2.0mm) using different surface conditioning methods (n=20): nonetched control (CTRL), or etched for 60s with different HF concentrations: 1% (HF1), 5% (HF5), or 10% (HF10). All the ceramic discs received a silane application (Monobond Plus). The epoxy discs were etched with 10% HF for 60s and received a primer coating (Multilink Primer A+B). Adhesively cementation was performed (Multilink Automix), and the assemblies (ceramic discs/epoxy discs) were subjected to cyclic loads in water by a staircase approach (500,000 cycles; 20Hz; initial load=290N; step size=30N). Fatigue failure load data were analyzed using 1-way ANOVA and post-hoc Tukey’s tests (α=.05). ResultsMean failure load of the HF5 group (255.0±23.0N) was significantly lower; HF1 group (301.7±71.0N) presented intermediate values, and the highest values were achieved in CTRL (351.7±13.4N) and HF10 (341.7±20.6N) groups. All the failures were radial cracks starting from the bonding surface. SignificanceIn terms of fatigue failure load, etching with 1% and 5% HF had a deleterious effect on the fatigue behavior of an adhesively cemented feldspathic ceramic, while 10% HF had no negative influence.

Simplified cementation of lithium disilicate crowns: Retention with various adhesive resin cement combinations

Statement of problemA composite resin cement and matching self-etch adhesive was developed to simplify the dependable retention of lithium disilicate crowns. The efficacy of this new system is unknown. PurposeThe purpose of this in vitro study was to determine whether lithium disilicate crowns cemented with a new composite resin and adhesive system and 2 other popular systems provide clinically acceptable crown retention after long-term aging with monthly thermocycling. Material and methodsExtracted human molars were prepared with a flat occlusal surface, 20-degree convergence, and 4 mm axial length. The axio-occlusal line angle was slightly rounded. The preparation surface area was determined by optical scanning and the analysis of the standard tessellation language (STL) files. The specimens were distributed into 3 cement groups (n=12) to obtain equal mean surface areas. Lithium disilicate crowns (IPS e.max Press) were fabricated for each preparation, etched with 9.5% hydrofluoric acid for 15 seconds, and cleaned. Cement systems were RelyX Ultimate with Scotch Bond Universal (3M Dental Products); Monobond S, Multilink Automix with Multilink Primer A and B (Ivoclar Vivadent AG); and NX3 Nexus with OptiBond XTR (Kerr Corp). Each adhesive provided self-etching of the dentin. Before cementation, the prepared specimens were stored in 35°C water. A force of 196 N was used to cement the crowns, and the specimens were polymerized in a 35°C oven at 100% humidity. After 24 hours of storage at 100% humidity, the cemented crowns were thermocycled (5°C to 55°C) for 5000 cycles each month for 6 months. The crowns were removed axially at 0.5 mm/min. The removal force was recorded and the dislodgement stress calculated using the preparation surface area. The type of cement failure was recorded, and the data were analyzed by 1-way ANOVA and the chi-square test (α=.05) after the equality of variances had been assessed with the Levene test. ResultsThe Levene test was nonsignificant (P=.936). The ANOVA revealed the mean removal stresses, and forces did not differ for RelyX Ultimate with Scotchbond Universal (3.9 MPa; 522 N) and Multilink Automix with Multilink Primer (3.7 MPa; 511 N); both differed significantly (P=.022) from the mean for NX3 Nexus with OptiBond XTR (2.9 MPa; 387 N). For all 3 cements, the modes of failure showed cement principally on the crown intaglio, and the chi-square analysis was nonsignificant (P=.601). ConclusionsIPS e.max Press (lithium disilicate) crowns were well retained (2.9-3.9 MPa; 387-522 N) by the 3 cement-adhesive combinations after 6 months of aging with monthly thermocycling. These results can serve as a basis for cement selection for this type of crown because the values significantly exceeded those for zinc phosphate. Cements using their matched dentin bonding agent as the ceramic primer were as successful as cements with a separate silane coupling agent.

Fracture resistance of ceramic and polymer-based occlusal veneer restorations

ObjectivesThe purpose of this in vitro study was to evaluate the influence of thermodynamic loading on the durability and fracture resistance behavior of occlusal veneers fabricated from different biomedical dental CAD/CAM materials. MethodsThe occlusal surfaces of 64 extracted premolars were prepared in the enamel layer and restored with occlusal veneers with a fissure/cusp thickness of 0.5/0.8mm made from four different dental CAD/CAM materials: group LD lithium disilicate (e.max CAD), group LS zirconia-reinforced lithium silicate (Vita Suprinity), group PI polymer-infiltrated ceramic (Vita Enamic), and group PM polymethylmethacrylate PMMA (Telio CAD). The prepared teeth were etched with phosphoric acid. The occlusal veneers were then bonded using an adhesive luting system (Multilink Primer A/B and Multilink Automix luting resin). Half of the specimens were subjected to thermodynamic loading in a chewing simulator (1.2 million cycles at 98N). All specimens were quasi-statically loaded until fracture. The statistical analysis was made using the t-test and one-way ANOVA followed by the Tukey HSD test (α = 0.05). ResultsAll aged specimens survived the thermodynamic loading. Thermodynamic loading significantly raised the fracture resistance in groups LS, PI, and PM (P < 0.03). Occlusal veneers made from lithium disilicate and zirconia-reinforced lithium silicate recorded higher fracture resistance than those made from polymer-infiltrated ceramic and PMMA resin. ConclusionsAll tested dental CAD/CAM biomaterials exhibited a fracture resistance considerably exceeding the average occlusal force in the posterior dentition. Therefore, they might present a viable long-term treatment for restoring the occlusal surfaces of posterior teeth.

Correlative analysis of cement–dentin interfaces using an interfacial fracture toughness and micro-tensile bond strength approach

ObjectivesTo determine the interfacial fracture toughness (iFT) and micro-tensile strength (μTBS) of composite cements bonded to dentin. MethodsFifty feldspar ceramic blocks (Vita Mark II, Vita Zahnfabrik) were luted onto dentin using two self-adhesive (G-CEM LinkAce, GC; SpeedCEM, Ivoclar Vivadent), two self-etch (Multilink Primer & Multilink Automix, Ivoclar Vivadent; Scotchbond Universal & RelyX Ultimate, 3 M ESPE), and one etch-and-rinse (Excite F DSC & Variolink II, Ivoclar Vivadent) composite cement (n=10). After 48h in 100% relative humidity at 37°C, one half of each tooth was sectioned in sticks with a chevron notch at the cement–dentin interface and tested in a 4-point bending test setup (iFT). The remaining half of the tooth was sectioned in micro-specimens and stressed in tension until failure (μTBS). The mode of failure was determined with a stereomicroscope at 50× magnification. Data were submitted to Weibull analysis and Pearson’s correlation (α=0.05). ResultsAt 10% probability of failure, no significant differences could be found using iFT, while the etch-and-rinse composite cement Variolink II presented a significantly higher μTBS at this level. At 63.2% probability of failure, the self-adhesive composite cement G-CEM LinkAce revealed a significantly lower μTBS and iFT, and the self-etch cement Multilink Automix also revealed a significantly lower μTBS than all other cements. The correlation found between iFT and μTBS was moderate and not significant (r2=0.618, p=0.11). SignificanceOverall, the etch-and-rinse and ‘universal’ self-etch composite cements performed best. The micro-tensile bond strength and interfacial fracture toughness tests did not correlate well.

Influence of restoration thickness and dental bonding surface on the fracture resistance of full-coverage occlusal veneers made from lithium disilicate ceramic

ObjectivesThe purpose of this in-vitro study was to evaluate the influence of ceramic thickness and type of dental bonding surface on the fracture resistance of non-retentive full-coverage adhesively retained occlusal veneers made from lithium disilicate ceramic. MethodsSeventy-two extracted molars were divided into three test groups (N=24) depending on the location of the occlusal veneer preparation: solely within enamel, within enamel and dentin or within enamel and an occlusal composite resin filling. For each test group, occlusal all-ceramic restorations were fabricated from lithium disilicate ceramic blocks (IPS e.max CAD) in three subgroups with different thicknesses ranging from 0.3 to 0.7mm in the fissures and from 0.6 to 1.0mm at the cusps. The veneers were etched (5% HF), silanated and adhesively luted using a self etching primer and a composite luting resin (Multilink Primer A/B and Multilink Automix). After water storage at 37°C for 3 days and thermal cycling for 7500 cycles at 5–55°C, specimens were subjected to dynamic loading in a chewing simulator with 600,000 loading cycles at 10kg combined with thermal cycling. Unfractured specimens were loaded until fracture using a universal testing machine. Statistical analysis was performed using Kruskal–Wallis and Wilcoxon tests with Bonferroni–Holm correction for multiple testing. ResultsOnly specimens in the group with the thickest dimension (0.7mm in fissure, 1.0mm at cusp) survived cyclic loading without any damage. Survival rates in the remaining subgroups ranged from 50 to 100% for surviving with some damage and from 12.5 to 75% for surviving without any damage. Medians of final fracture resistance ranged from 610 to 3390N. In groups with smaller ceramic thickness, luting to dentin or composite provided statistically significant (p≤0.05) higher fracture resistance than luting to enamel only. The thickness of the occlual ceramic veneers had a statistically significant (p≤0.05) influence on fracture resistance. SignificanceThe results suggest to use a thickness of 0.7–1mm for non-retentive full-coverage adhesively retained occlusal lithium disilicate ceramic restorations.

Restoration of endodontically treated teeth with major hard tissue loss – influence of post surface design on pull‐out bond strength of fiber‐reinforced composite posts

The aim was to evaluate the influence of post surface design and luting system on bond strength of quartz-fiber-reinforced composite posts (QFRCPs) luted to root canal dentin. Single-rooted bovine teeth (n=650) were randomly assigned (13 groups, n=50), sectioned, endodontically treated, filled, and post space (length 8mm) prepared. Custom-made plain-surfaced fiber posts (PSXRO) and (both RTD) macroretentive Macro-Lock Post Illusion X-RO (MLXRO) were inserted into the post spaces using six luting systems: Ketac Cem (KC), Fuji Plus (FP), RelyX Unicem, Multilink Primer_Multilink, Sealbond Ultima_CoreCem, and LuxaBond_LuxaCore Z. As control, a titanium post was cemented with KC. After water storage (24h, 37°C), pull-out test was performed, followed by failure mode assessment. Bond strength was calculated in MPa and analyzed using anova, Dunnett-T3-test, and Student's t-test with Bonferroni correction. Post design and luting system significantly influenced the bond strength [MPa] (P<0.05). Compared with the control 4.3 (1.5), all test groups exhibited higher bond strengths (P<0.05), except for group PSXRO/KC 4.2 (1.0). The remaining bond strengths were PSXRO: FP 8.6 (1.5), RelyX Unicem 10.4 (3.4), Multilink Primer_Multilink 12.7 (3.0), SealBond Ultima_CoreCem 12.7 (3.0), LuxaBond_LuxaCore Z 15.7 (2.5), and MLXRO: KC 7.2 (2.2), FP 13.4 (2.5), RelyX Unicem 9.2 (2.9), Multilink Primer_Multilink 12.5 (4.5), SealBond Ultima_CoreCem 13.7 (4.6), LuxaBond_LuxaCore Z 20.6 (2.2). The bond strengths of MLXRO were higher than those of PSXRO when luted with KC, FP, and LuxaBond_LuxaCore Z (P<0.05). The post surface design and luting system selection influenced the bond strength of conventionally and adhesively luted QFRCPs to bovine root canal dentin.

Restoration of endodontically treated teeth with major hard tissue loss – bond strength of conventionally and adhesively luted fiber‐reinforced composite posts

To evaluate the influence of the luting system on the pull-out bond strength of conventionally and adhesively luted fiber-reinforced composite posts (FRCPs). One hundred extracted bovine teeth (Di 3) were endodontically treated and randomly assigned to nine test groups and one control group (n = 10) according to luting system. After preparing the post cavities (8 mm), the custom-made FRCPs were inserted using conventional glass-ionomer cement (Ketac Cem), resin-reinforced glass-ionomer cement (Meron Plus and Fuji Plus), self-adhesive resin cement (RelyX Unicem and BisCem), self-conditioning adhesive and resin cement [Multilink Primer + Multilink and AdheSE + DC Activator + MultiCore Flow, or etch-and-rinse adhesive and resin cement (SealBond Ultima + CoreCem, and LuxaBond + LuxaCore Z). As a control, custom-made titanium posts were inserted with Ketac Cem. After water storage (37°C, 24 h, dark), the pull-out test was performed, followed by failure mode evaluation. The data were statistically analyzed (α = 0.05) using analysis of variance and the Dunnett T3 post hoc test. Luting system type and identity significantly influenced bond strength (P < 0.001); the bond strengths of all luting systems except Ketac Cem, MeronPlus, and BisCem were significantly higher than the control (4.4 ± 1.1 MPa). RelyX Unicem (12.0 ± 3.0 MPa) and LB + LCZ (14.8 ± 2.3 MPa) generated the highest bond strengths. The clinical application was demonstrated by restoring a traumatized tooth with extensive coronal destruction and thin root canal walls, using a FRCP combined with direct composite build-up. Luting system selection significantly influenced the bond strength of conventionally and adhesively luted FRCPs to bovine root canal dentin.

Bond Strength of Two Resin Cements on Dentin Using Different Cementation Strategies

This study evaluated the microtensile bond strength of two resin cements to dentin either with their corresponding self-etching adhesives or employing the three-step "etch-and-rinse" technique. The null hypothesis was that the "etch-and-rinse" adhesive system would generate higher bond strengths than the self-etching adhesives. Thirty-two human molars were randomly divided into four groups (N = 32, n = 8/per group): G1) ED Primer self-etching adhesive + Panavia F; G2) All-Bond 2 "etch-and-rinse" adhesive + Panavia F; G3) Multilink primer A/B self-etching adhesive + Multilink resin cement; G4) All-Bond 2 + Multilink. After cementation of composite resin blocks (5 x 5 x 4 mm), the specimens were stored in water (37 degrees C, 24 hours), and sectioned to obtain beams (+/-1 mm(2) of adhesive area) to be submitted to microtensile test. The data were analyzed using 2-way analysis of variance and Tukey's test (alpha = 0.05). Although the cement type did not significantly affect the results (p = 0.35), a significant effect of the adhesive system (p = 0.0001) was found on the bond strength results. Interaction terms were not significant (p = 0.88751). The "etch-and-rinse" adhesive provided significantly higher bond strength values (MPa) with both resin cements (G2: 34.4 +/- 10.6; G4: 33.0 +/- 8.9) compared to the self-etching adhesive systems (G1: 19.8 +/- 6.6; G3: 17.8 +/- 7.2) (p < 0.0001). Pretest failures were more frequent in the groups where self-etching systems were used. Although the cement type did not affect the results, there was a significant effect of changing the bonding strategy. The use of the three-step "etch-and-rinse" adhesive resulted in significantly higher bond strength for both resin cements on dentin. Dual polymerized resin cements tested could deliver higher bond strength to dentin in combination with "etch-and-rinse" adhesive systems as opposed to their use in combination with self-etching adhesives.

Effect of cyclic loading on bonding of fiber posts to root canal dentin

This study evaluated the effect of mechanical loading on microtensile bond strength (MTBS) when luting fiber posts to root canal dentin. Forty maxillary premolars were endodontically treated, and the roots were prepared for post cementation using the FRC Postec system. A light-cured composite (Clearfil Photo Core, Kuraray) was used in combination with four adhesive systems: Single Bond (3M ESPE), Multilink Primer (Vivadent), Clearfil Photo Bond (Kuraray), and Clearfil New Bond (Kuraray). A composite build-up was performed around the root to provide adequate gripping during testing. For each experimental group, half of the specimens were load cycled under 90 N (5000 cycles, 3 cycles/s). Specimens were cut to obtain beams with the post in the center and with the radicular dentin overlaid by the composite build-up on each side. Microtensile testing was performed with a universal testing machine at a cross-head speed of 0.5 mm/min. The failure mode was classified under a stereomicroscope. ANOVA and Student-Newman-Keuls multiple comparison tests were performed. After 24 h, all adhesives performed similarly. When specimens were subjected to mechanical loading, decreases in MTBS were observed for Clearfil New Bond and Multilink Primer.

Luting of ceramic inlays in vitro: Marginal quality of self-etch and etch-and-rinse adhesives versus self-etch cements

Objectives To evaluate marginal integrity of IPS Empress inlays luted with different adhesives and cements before and after thermo-mechanical loading (TML). Methods MOD cavities with one proximal box beneath the cementoenamel junction were prepared in 72 extracted human third molars. IPS Empress inlays were luted with nine combinations of adhesive and luting composite or self-etch cement alone ( n = 8): Prime&Bond NT Dual-Cure + Calibra (PC), XP BOND/SCA + Calibra (XC), XP BOND/SCA light-cured + Calibra (XL), Syntac + Variolink II (SV), Multilink Primer + Multilink (ML), AdhesSE DC + Variolink II (AV), ED Primer + Panavia F 2.0 (EP), RelyX Unicem (RU), and Maxcem (MC). Marginal quality was analyzed under an SEM using epoxy resin replicas before and after thermo-mechanical loading (100,000 × 50 N and 2500 thermocylces between +5 and +55 °C). Results All systems involving the etch-and-rinse approach resulted in significantly higher percentages of gap-free margins in enamel than all other luting systems ( p < 0.05). ML and AV achieved higher percentages of gap-free margins in enamel than EP and RU ( p < 0.05), with EP and RU being significantly above MC ( p < 0.05). For dentine margins, XP Bond resulted in significantly higher percentages of gap-free margins than Prime&Bond NT, independent of a separate light-curing step ( p < 0.05). Between the luting systems XC, XL, SV, ML, AV, ED, EP, and RU, no significant differences were computed ( p > 0.05). MC ranged at the end of the statistical subsets with 62% gap-free margins ( p < 0.05; Mann–Whitney U-test). Significances Etch-and-rinse adhesives combined with conventional luting resin composites reveal still the best prognosis for adhesive luting of glass ceramic inlays.

Effects of adhesive systems and luting agents on bonding of fiber posts to root canal dentin

The study evaluated the influence of different luting materials on the microtensile bond strength of glass fiber posts to root canal dentin. Thirty extracted maxillary premolars were endodontically treated, and the roots were prepared for post cementation using the FRC Postec system (Vivadent). Two luting materials (Multilink, Vivadent and Clearfil Photo Core, Kuraray) were used in combination with three adhesive: Multilink Primer (Vivadent), Clearfil Photo Bond, and Clearfil New Bond (Kuraray). A composite build-up was performed around the root to provide adequate gripping during testing. Specimens were cut to obtain beams with the post in the center and with the radicular dentin overlaid by the composite build-up on each side. Microtensile testing was performed with a universal testing machine at a cross-head speed of 0.5 mm/min. The failure mode was classified under a stereomicroscope and four representative beams of each group were selected for SEM analysis. Bond strength data that were analyzed with two-way ANOVA and Student-Newman-Keuls multiple comparisons tests revealed that adhesive systems, luting materials, and the interaction between these two factors significantly influenced the bond strength results (p < 0.01). Multilink applied with its own adhesive system obtained the best results, while the lowest bond strength was achieved with clearfil photo core in combination with multilink primer.