Current ceramic materials offer preferred optical properties for highly esthetic restorations. The inherent brittleness of some ceramic materials, specific treatment modalities, and certain clinical situations require resin bonding of the completed ceramic restoration to the supporting tooth structures for long-term clinical success. This article presents a literature review on the resin bond to dental ceramics. A PubMed database search was conducted for in vitro studies pertaining to the resin bond to ceramic materials. The search was limited to peer-reviewed articles published in English between 1966 and 2001. Although the resin bond to silica-based ceramics is well researched and documented, few in vitro studies on the resin bond to high-strength ceramic materials were identified. Available data suggest that resin bonding to these materials is less predictable and requires substantially different bonding methods than to silica-based ceramics. Further in vitro studies, as well as controlled clinical trials, are needed.

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Resin-ceramic bonding: a review of the literature.

A study has been made of the effects of sandblasting on the strength of Y-TZP and alumina ceramic layers joined to polymeric substrates and loaded at the top surfaces by a spherical indenter, in simulation of occlusal contact in ceramic crowns on tooth dentin. The sandblast treatment is applied to the ceramic bottom surface before bonding to the substrate, as in common dental practice. Specimens with polished surfaces are used as a control. Tests are conducted with monotonically increasing (dynamic) and sinusoidal (cyclic) loading on the spherical indenter, up to the point of initiation of a radial fracture at the ceramic bottom surface immediately below the contact. For the polished specimens, data from the dynamic and cyclic tests overlap, consistent with a dominant slow crack growth mode of fatigue. Strengths of sandblasted specimens show significant reductions in both dynamic and cyclic tests, indicative of larger starting flaws. However, the shift is considerably greater in the cyclic data, suggesting some mechanically assisted growth of the sandblast flaws. These results have implications in the context of lifetimes of dental crowns.

Effect of sandblasting on the long-term performance of dental ceramics.

Polymerization shrinkage and contraction stress of dental resin composites.

It is widely accepted that volumetric contraction and solidification during the polymerization process of restorative composites in combination with bonding to the hard tissue result in stress transfer and inward deformation of the cavity walls of the restored tooth. Deformation of the walls decreases the size of the cavity during the filling process. This fact has a profound influence on the assumption--raised and discussed in this paper--that an incremental filling technique reduces the stress effect of composite shrinkage on the tooth. Developing stress fields for different incremental filling techniques are simulated in a numerical analysis. The analysis shows that, in a restoration with a well-established bond to the tooth--as is generally desired--incremental filling techniques increase the deformation of the restored tooth. The increase is caused by the incremental deformation of the preparation, which effectively decreases the total amount of composite needed to fill the cavity. This leads to a higher-stressed tooth-composite structure. The study also shows that the assessment of intercuspal distance measurements as well as simplifications based on generalization of the shrinkage stress state cannot be sufficient to characterize the effect of polymerization shrinkage in a tooth-restoration complex. Incremental filling methods may need to be retained for reasons such as densification, adaptation, thoroughness of cure, and bond formation. However, it is very difficult to prove that incrementalization needs to be retained because of the abatement of shrinkage effects.

Does an Incremental Filling Technique Reduce Polymerization Shrinkage Stresses

How should composite be layered to reduce shrinkage stress: incremental or bulk filling?

This study evaluated porcelain repair by use of various surface treatments and hydrophilic bonding resins. The surface treatments were air abrasion (sandblasting), roughening with a diamond, etching with 9.6% hydrofluoric acid, and a combination of the latter two methods. A silane coupling agent was applied to all porcelain surfaces, and composite resin was bonded to porcelain with All-Bond 2, Amalgambond, or Clearfil Porcelain bonding agents. Shear bond strengths were determined on a universal testing machine. The most effective surface treatment was the combination of diamond roughening and hydrofluoric acid etching, but it was not significantly better than the other methods. The Clearfil Porcelain Bond system showed a greater repair strength than the other two materials but was statistically different only from Amalgambond resin.

Effects of surface treatment and bonding agents on bond strength of composite resin to porcelain

Cusp movement in premolars resulting from composite polymerization shrinkage

Polymerization shrinkage of two posterior composite resin restorative materials was measured by dilatometry. The results were compared with a decrease in cavity width of MOD preparations in extracted premolars restored with the composite resins. A highly filled hybrid composite exhibited greater free shrinkage and cuspal deformation than a hybrid composite with a lower filler content. Deformation of the cusps was less than the unrestricted shrinkage of the composite resins. Hydrated teeth exhibited less deformation than dehydrated teeth because of polymerization shrinkage. Greater cuspal deformations were measured with the microscopic technique than with interferometry because of differences in experimental design.

Polymerization shrinkage of composite resins: Comparison with tooth deformation

A Michelson interferometry apparatus was used for measurement of the displacement of the buccal cusps of premolars after restoration of MOD preparations with composites. The effects of composite type, cavity size, and hydration conditions were examined. Interferometry permitted real-time measurement of cusp movement as it occurred. Contraction occurred very rapidly, about 1/3 of the 60-minute amount within the two-minute period of exposure to the curing light. Cusp movement was smooth rather than interrupted, indicating lack of microfracturing at deformations of 11-46 microns. Contraction, 0.94% for Heliomolar and 1.2% for P-50, was similar to the linear polymerization shrinkage of the resins. Less cusp movement occurred in small cavities than in large cavities. Hydrated teeth had less cusp movement than dehydrated teeth.

Interferometric Measurements of Cusp Deformation of Teeth Restored with Composites

OBJECTIVE To determine color and translucency stability of present-day resin-based restorative materials. MATERIALS AND METHODS Disk-shaped (1.0 × 10 mm) resin composites (Filtek Universal, 3M ESPE; Spectra ST, Dentsply Sirona; Gradia Direct X, GC America; Estilite Quick, Tokuyama; Harmonize, Kerr; ACTIVA Bioactive-Restorative, Pulpdent) were prepared and divided into four staining groups (n = 5); coffee (55°C), grape juice (5°C), deionized water (25°C) and thermocycling (20 000 cycles, 5°C to 55°C with a 30-second dwell time). Spectrophotometer measurements were taken at baseline and 14 days for each group and the color stability (CIEDE2000) and changes in the translucency parameter (RTPCIEDE2000 ) and luminous transmittance of each composite were determined. A 2-way analysis of variance (ANOVA) using maximum likelihood estimations was used for analysis for these changes, with subsequent pairwise comparisons using Bonferroni-corrected Student's t tests and an experiment-wise α = 0.05. RESULTS A significant interaction (P < .0001) between material and treatment was found for each change in the esthetic property tested over 14 days. Multiple significant differences between materials for each treatment and between treatments for each material were identified. CONCLUSIONS The severity of color change and translucency of resin-based materials are dependent on their type, mostly affected by the coffee staining medium. Nano-filled resin composite is most resistant to color change and with stable translucency after artificial aging. CLINICAL RELEVANCE Nano-filled resin composite may be the most esthetically durable resin- based restorative material. Micro-hybrid resin composite and resin-modified glass ionomer restorative material are susceptible to color change and losing their translucency. Hot coffee solution may shorten the esthetic lifespan of a resin-based material.

Abdulhaq Suliman

Papers

Effects of surface treatment and bonding agents on bond strength of composite resin to porcelain

Cusp movement in premolars resulting from composite polymerization shrinkage

Polymerization shrinkage of composite resins: Comparison with tooth deformation

Interferometric Measurements of Cusp Deformation of Teeth Restored with Composites

Color and translucency stability of contemporary resin-based restorative materials.