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Surface Treatments for Repair of Feldspathic, Leucite - and Lithium

Disilicate-Reinforced Glass Ceramics Using Composite Resin

Article in Brazilian Dental Journal · March 2015

DOI: 10.1590/0103-6440201302447 · Source: PubMed

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Nadine Luísa Guimarães Albuquerque Érica Alves Gomes

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Brazilian Dental Journal (2015) 26(2): 152-155 ISSN 0103-6440
http://dx.doi.org/10.1590/0103-6440201302447

Surface Treatments for Repair of

1IMED - Meridional University,
School of Dentistry, Department
of Prosthodontics and Dental
Feldspathic, Leucite- and Lithium Materials, Passo Fundo, RS, Brazil
2UFC - Federal University of Ceará,

Disilicate-Reinforced Glass School of Pharmacy, Dentistry and

Nursing, Department of Restorative
Ceramics Using Composite Resin Dentistry, Fortaleza, CE, Brazil
3Piracicaba Dental School,

UNICAMP - University of Campinas,

Department of Prosthodontics and
Periodontics, Piracicaba, SP, Brazil
Christian Alencar Neis1, Nadine Luísa Guimarães Albuquerque2, Ivo de Souza
Albuquerque2, Erica Alves Gomes1, Celso Bernardo de Souza-Filho1, Victor
Pinheiro Feitosa2, Aloisio Oro Spazzin1, Atais Bacchi1,3 Correspondence: Atais Bacchi,
Rua Evaristo Tagliari, 430/102,
99010-470 Passo Fundo, RS, Brasil.
Tel: +55-54-3045-6100. e-mail:
[email protected]
The aim of this study was to evaluate the efficacy of different surface conditioning
methods on the microtensile bond strength of a restorative composite repair in three
types of dental ceramics: lithium disilicate-reinforced, leucite-reinforced and feldspathic.
Twelve blocks were sintered for each type of ceramic (n=3) and stored for 3 months in
distilled water at 37 °C. The bonding surface of ceramics was abraded with 600-grit SiC
paper. Surface treatments for each ceramic were: GC (control) - none; GDB - diamond
bur #30 µm; GHF - hydrofluoric acid (10%); GT- tribochemical silica coating (45-μm
size particles). Treatments were followed by cleaning with phosphoric acid 37% for 20
s + silane + adhesive. The composite resin was used as restorative material. After repair,
samples were subjected to thermocycled ageing (10,000 cycles between 5 °C and 55
°C for 30 s). Thereafter, the samples were sectioned into 1.0 mm2 sticks and tested for
microtensile bond strength with 0.5 mm/min crosshead speed. Data were compared by
two-way ANOVA and Tukey’s test (α=0.05). The superficial wear with diamond bur proved
to be suitable for feldspathic porcelain and for leucite-reinforced glass ceramic while
hydrofluoric acid-etching is indicated for repairs in lithium disilicate-reinforced ceramic;
tribochemical silica coating is applicable to leucite-reinforced ceramic. Predominance of
adhesive failures was observed (>85% in all groups). In conclusion, the success of surface Key Words: dental ceramics,
treatments depends on the type of ceramic to be repaired. repairs, surface treatments.

Introduction adhesion to restorative material. Traditionally, surface

Ceramic restorations have been employed for their treatment for ceramics involves roughening with diamond
innumerous advantages such as color stability, low thermal burs (7-9), etching with hydrofluoric acid (8,10-12) or
conductivity, resistance to wear and biocompatibility. tribochemical process based on silica-coated aluminum-
However, ceramics without metallic support are prone oxide particles (11-17). For restorative material bonding,
to crack propagation (1). The feldspathic ceramics used use of silane is recommended for glasses and porcelains in
as veneer are commonly affected by shipping, fracture order to obtain a mesh of siloxane with the silica on the
or excessive wear, mainly when supported by zirconia ceramic surface, to improve the bond strength between
frameworks (2). In this way, direct repair with a composite the ceramic and luting material and to increase the surface
resin appears as an attractive alternative due to the low energy for adhesive application (18).
cost, fast resolution, and preservation of supporting The aim of this study was to evaluate the microtensile
structures (3-5). bond strength after composite resin repairs in glass-
Glass-reinforced ceramics have been also emphasized. ceramics after different surface treatments. The null
Actually, the most popular are the leucite- and the lithium hypothesis of the study was that there is no difference
disilicate-reinforced ones. Both may be used to obtain among the tested techniques.
veneers, inlays, onlays and crowns. Monolithic application
of these ceramics for crowns has been employed to provide Material and Methods
higher resistance than the bi-layer restorations (6), although The following ceramics were used in this study:
fractures and wear may also occur in this type of restoration. feldspathic ceramic (Vita VM7, Vita Zahnfabrik, Bad
Surface preparation in fractured ceramic must be Säckingen, Germany), leucite-reinforced glass-ceramic (IPS
performed in the repair procedure that involves mechanical Empress, Ivoclar Vivadent, Schaan, Liechtenstein), lithium
or chemical surface preparations to create irregularities on disilicate-reinforced glass ceramic (IPS E.max Press, Ivoclar
the surface. Bonding components are also required for the Vivadent). Twelve blocks (10.0 x 7.0 x 3.0 mm) were obtained
 Braz Dent J 26(2) 2015

for each ceramic and aged in distilled water for 3 months classified as adhesive, mixed or cohesive.
at 37 °C. The bonding surface of all ceramic blocks was Data were processed using SPSS software (version 20;
abraded for 15 s with 600-grit silicon carbide paper and IBM, Armonk, NY, USA) by two-way ANOVA. Post-hoc
cleaned using ultrasound for 10 min. tests were calculated using the Tukey’s test. All tests were
The blocks were randomly divided (n=3) in four groups conducted at 95% confidence interval (α=0.05).
according surface treatments, as follows: GC (control
group) - no surface treatment; GDB: surface wear by Results
30-µm-grit diamond bur during 20 s under water cooling; Mean values (MPa) and standard deviation for all
GHF: hydrofluoric acid (10%) during 90 s for feldspathic groups are presented in Table 1. Statistical analysis revealed
ceramic, 60 s for leucite-reinforced glass-ceramic, and that for feldspathic ceramic no experimental treatment
20 s for lithium disilicate-reinforced glass ceramic; GT: increased µTBS in comparison with GC. However, the group
tribochemical process: sandblasting with silica-coated subjected to tribochemical process had significantly lower
aluminum oxide (45-µm size particles) for 20 s, at a distance results than the other groups (p<0.001), presenting pre-test
of 10 mm, perpendicular to the adhesion surface, under failures in all sticks. For the leucite-reinforced glass ceramic
2.8 bar pressure. (IPS Empress), GDB and GT did not differ from GC, while
In all ceramic blocks, the surface treated by the different GHF showed lower µTBS values (p<0.001). For the lithium
protocols was cleaned with 37% phosphoric acid (Condac disilicate-reinforced glass ceramic (IPS E.max press), GHF
37, FGM Dental Products, Joinvile, SC, Brazil) for 30 s, showed significantly higher µTBS values than GC, GBD and
followed by silane application (Angelus Dental Products, GT (p<0.001), which were similar among them. Interaction
Londrina, PR, Brazil) for 1 min. An adhesive system was used between the factors (ceramic type and surface treatment)
as bonding agent (Adapter Singlebond 2; 3M/ESPE, St. Paul, was statistically significant (p<0.001).

Composite resin repairs in ceramics

MN, USA) and light-cured for 20 s using an irradiance of Failure patterns are presented in Table 2. Predominance
800 mW/cm (BluePhase LED; Ivoclar Vivadent). Composite of adhesive failures (>85% in all groups) was observed.
resin (Filtek Z350; 3M/ESPE) was used as restorative material Mixed failures presented a small proportion (<8% in all
by the incremental technique and light-cured for 30 s as groups) and cohesive failures did not exceed 5.2% in all
previously described until obtaining a 3-mm thickness. A groups.
single operator performed the complete repair process.
Samples were submitted to thermocycling process Discussion
(10,000 cycles, between 5 °C and 55 °C for 30 s in each bath). This study showed that the surface treatment influenced
After the ageing procedure, the specimens were sectioned the µTBS of all tested ceramics. Therefore, the null hypothesis
in serial slabs (1 mm thick) using a diamond-embedded
blade under continuous water irrigation (Buehler, Lake
Bluff, IL, USA) and subsequently in 1 mm2 match-sticks Table 2. Failure patterns (%) for the different surface treatments and
ceramics features
and subjected to the microtensile bond strength (µTBS)
evaluation in a universal testing machine (EZ-test, Shimadzu Failure mode (%)
Group Ceramic
Co., Kyoto, Kansai, Japan) at a crosshead speed of 0.5 mm/ Adhesive Mixed Cohesive
min. Data were obtained in MPa. The failure pattern was
GC Feldspathic 95.3 4.7 0
evaluated by a stereomicroscope (Leica Microsystems,
Wetzler, Germany) at 60× magnification and failures were GC Leucite 94.8 5.2 0

GC Disilicate 93.3 6.7 0

GDB Feldspathic 89.8 5.8 4.4

Table 1. Mean values (MPa) and standard deviations for the different
groups in each ceramic GDB Leucite 91.3 7.6 1.1

Lithium disilicate- GDB Disilicate 93.9 6.1 0

Groups Feldspathic Leucite-reinforced
reinforced
GHF Feldspathic 87.7 7.1 5.2
GC 9.0 (10.0) B ab 17.9 (3.4) A a 4.6 (1.3) B b
GHF Leucite 91.8 6.0 2.2
GDB 13.9 (1.99) B a 22.4 (4.4) A a 4.4 (2.6) C b
GHF Disilicate 96.5 3.5 0
GHF 14.4 (4.44) B a 3.7 (0.4) C b 21.1 (5.2) A a
GT Feldspathic 100.0 0 0
GT 0 (0) C b 21.7 (2.5) A a 8.3 (5.5) B b
GT Leucite 95.5 3.1 1.4
Different uppercase letters indicate in rows and lowercase letters in
GT Disilicate 96.4 2.4 1.2
columns indicate statistically significant difference (p=0.05).
153
 Braz Dent J 26(2) 2015

was rejected. Additionally, it was observed that the success roughness probably acts as a mechanical preparation
of surface treatment depends on the ceramic type. For the providing roughness on the ceramic surface. In this way,
lithium disilicate-reinforced glass ceramic, the etching with the results of this study showed µTBS values in GC of
hydrofluoric acid promoted the highest µTBS values, which feldspathic and leucite-reinforced ceramic comparable to
is in agreement with Colares et al. (10). This ceramic has the those of other mechanical surface treatments. However,
lowest vitreous proportion among the ceramics tested in this for lithium disilicate ceramic the GC was similar to other
study. Therefore, it seems that the chemical conditioning mechanical treatments, which were significantly lower
is most efficient to infiltrate and remove the vitreous than HF etching.
phase, creating irregularities in the surface. For leucite- The failure patterns observed in this study showed
reinforced glass ceramic, the etching with hydrofluoric a great prevalence of adhesive failures for all groups,
acid was the only tested surface treatment that showed ranging from 85 to 100%. Based on these results, it was
lower µTBS compared with control and the other tested not possible to establish a relation of failure pattern with
groups. Since this ceramic has a higher vitreous proportion µTBS for the used surface treatments. Other analyses
in comparison to lithium disilicate, it was suggested that showed that adhesive failures are the most observed for
mechanical treatments such as the use of diamond burs repaired ceramic interfaces (16), some studies presenting
are more efficient to create irregularities. The success of 100% prevailance (12,14). This information may suggest
tribochemical process for leucite-reinforced glass ceramic, that bond strength of repairs on ceramic surfaces are not
which involves the creation of irregularities by sandblasting comparable to the bulk strength of the materials, thus its
with aluminum oxide silica-coated particles and chemical clinical prognostic success may be related to application
improvement by silica deposition on the ceramic surface, in areas of low occlusal load.
is also in agreement with previous reports (14). Ceramic fractures may result from several factors, such
For the feldspathic ceramic, the tribochemical process as inadequate occlusal adjustment, failure in the bonding
was the only tested surface treatment that promoted interface, internal porosities, parafunctional habits, and
lower values of µTBS in comparison with other tested internal stress from the manufacturing process (1). The
C.A. Neis et al.

groups. In fact, this type of ceramic showed pre-testing repair is characterized by a faster and low-cost method
failures during the tribochemical process for all samples if compared to replacement of the entire restoration (3-
during the stick preparation, like weak bond strength, 5). This study has shown that using the correct surface
which lead to failures previous to the testing method, even treatment for each ceramic is the key for success in repair
during stick preparation or handling them, characterizing procedure. The methods here employed are traditional
a bond strength equal to zero in the results section. This treatments used in dental clinic. Roughness with diamond
process is characterized by silica deposition on the ceramic bur might be considered the most practical among them
surface, used mainly for bonding on crystalline ceramics as because it does not require any additional precaution or
zirconia and alumina. Therefore, it may be suggested that protection of the patient than those traditionally used
silica deposition on feldspathic ceramic has a long-term and does not need the use of other apparatus than the
low stability. Nevertheless, the present results are different traditional burs. Etching with hydrofluoric acid needs
from those of Attia (7) who found that the tribochemical complete rubber dam isolation of the teeth to be applied
treatment showed similar values of µTBS in relation to on, as it is irritating to oral tissues. The tribochemical
diamond bur preparation and also diverge from the study of process also needs rubber dam isolation for protecting
Melo et al. (11) where tribochemical process was similar to the mouth from the sandblasted silica-coated aluminum
etching with hydrofluoric acid. However, it is important to oxide particles.
highlight that those studies did not use the ageing process Within the limitations of this study, considering the
for the bonded interface, as the thermocycling used in this evaluated materials and techniques, it may be concluded
study, which may have caused the interface degradation. As that diamond burs can be used as surface treatment for
regards the success of other surface treatments (groups GHF repairs in feldspathic and leucite-reinforced ceramics;
and GDB) used in this study to repair feldspathic ceramics, hydrofluoric acid etching is indicated for repair of lithium
they are in agreement with other studies (7,8,11). disilicate-reinforced ceramic and tribochemical process in
These observations for efficacy of mechanical or successfully used for repairs of leucite-reinforced ceramic.
chemical methods for conditioning depending on the The success of surface treatment depends on the type of
ceramic’s type are also supported by the data of control ceramic to which it is applied.
group for all ceramics. The silicone grit paper used in all
samples to remove the superficial ceramic layer simulating Resumo
the repair and also used to standardize the surface O objetivo deste estudo foi avaliar a eficácia de diferentes
154
 Braz Dent J 26(2) 2015

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