Art-1-no4-y2020
DENTAL MATERIALS www.stomaeduj.com
THE MICRO-SHEAR BOND STRENGTH OF TWO
Original Articles
DIFFERENT REPAIR SYSTEMS TO INDIRECT RESTORATIVE
MATERIALS
Ayșe Atay1a* , Lamia Najafova2b , Huseyin Mehmet Kurtulmus2c , Aslihan Üşümez3d
1
Department of Prosthodontics, Faculty of Dentistry, Altinbaș University, TR-34147, Bakırkoy/Istanbul, Turkey
2
Department of Prosthodontics, Faculty of Dentistry, Istanbul Aydin University, TR-34295, Kucukcekmece/Istanbul, Turkey
3
Private Clinic, TR-34147, Bakırkoy/Istanbul, Turkey
a
DDS, PhD, Assistant Professor; e-mail: ayse.atay@altinbas.edu.tr; ORCIDiD: https://orcid.org/0000-0002-5358-0753
b
DDS, Lecturer; e-mail: lamia.najaf@gmail.com; ORCIDiD: https://orcid.org/0000-0001-6900-8308
c
DDS, PhD; e-mail: h_kurtulmus@yahoo.com; ORCIDiD: https://orcid.org/0000-0001-5013-3766
d
DDS, PhD; e-mail: asli_u@hotmail.com; ORCIDiD: https://orcid.org/0000-0002-7222-7322
ABSTRACT https://doi.org/10.25241/stomaeduj.2020.7(4).art.1
Introduction The aim of this study was to evaluate the micro-shear bond strength (μSBS) of different repair
systems (Clearfil Repair, iGOS Repair) to restorative materials for CAD/CAM (Cerasmart, Lava Ultimate, InCoris
TZI , VITA Suprinity, VITA Mark II, IPS e.max CAD, IPS Empress CAD).
Methodology The 140 1.2 mm-thick specimens were prepared from CAD/CAM blocks (n=20) and
thermocycled (10,000 cycles, 5–55°C, dwell time 20s). The specimens were randomly divided into two
groups according to the repair system: Clearfil Repair (40% phosphoric acid+mixture of Clearfil Porcelain
Bond Activator and Clearfil SE Bond Primer+Clearfil SE Bond+CLEARFIL MAJESTY ES-2) and iGOS Repair
(40% phosphoric acid+ Multi Primer LIQUID+ iGOS Bond+ iGOS Universal). The composite resins were
polymerized. All specimens were stored in distilled water at 37°C for 24 hours. The μSBS test was performed
with a micro-shear testing machine (at 1 mm/min). The data were analyzed using two-way ANOVA, Tukey’s
multiple comparison tests at a significance level of p<0.05. Each failure modes were examined under a
stereomicroscope at×16 magnification.
Results The type of CAD/CAM restorative material and repair system showed a significant effect on the μSBS
(p<0.05). Specimens repaired with the iGOS Repair system showed the highest μSBS values than the Clearfil
Repair system among all tested materials except for the InCoris TZI group (p<0.05).
Conclusion All groups, except for the InCoris TZI group, repaired with iGOS Repair system showed higher
μSBS than Clearfil Repair. The type of restoration and repair material is important in the success of the fracture
repair.
KEYWORDS
Micro-Shear Bond Strength; Repair System; CAD-CAM Materials; Adhesion; Dental Prosthesis Repair.
1. INTRODUCTION restorations which arise from traditional construction
technique [1-4].
Advances in ceramic materials have enabled Nowadays, there are many types of CAD/CAM
the production and application of full ceramic materials mainly metal alloys, ceramic materials,
restorations without metal. Especially in the last composite resins, and PMMA’s. CAD/CAM ceramic
decade, the development of CAD/CAM systems blocks could be feldspathic ceramics, lithium
has provided improvement of full ceramic systems disilicate glass ceramics, yttrium tetragonal zirconia
and overcoming some of disadvantages of the polycrystals or leucite-reinforced glass ceramics.
OPEN ACCESS This is an Open Access article under the CC BY-NC 4.0 license.
Peer-Reviewed Article
Citation: Atay A, Najafova L, Kurtulmus HM, Üşümez A. The micro-shear bond strength of two different repair systems to indirect restorative materials.
Stoma Edu J. 2020;7(4):233-241.
Received: September 16, 2020; Revised: September 27, 2020; Accepted: October 25, 2020; Published: October 26, 2020
*Corresponding author: Assistant Professor Dr. Ayșe Atay, Department of Prosthodontics, Faculty of Dentistry, Altinbaș University, İncirli Avenue
No:11/A, 34147, Bakırkoy, Istanbul, Turkey
Tel.: +90-212-709 45 28, Fax: +90-212-445 81 71; e-mail: ayse.atay@altinbas.edu.tr
Copyright: © 2020 the Editorial Council for the Stomatology Edu Journal.
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Atay A, et al.
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Original Articles
Figure 2. Specimen testing.
Figure 1. Schematic illustration of specimen preparation.
Table 1. Brand names, groups, abbreviations, lot numbers, material types, compositions and manufacturers of the CAD/CAM restorative materials
used in the study.
Brand Name Material type Composition Manufacturer
Cerasmart Hybrid ceramic Matrix: Bis-MEPP, UDMA, DMA GC Corp., Tokyo, Japan
Filler: silica, barium glass nanoparticles (71 wt%)
Lava Ultimate Resin nano ceramic Matrix: Bis-GMA, UDMA, Bis-EMA, TEGDMA 3M ESPE, Seefeld,
Filler SiO2, ZrO2, aggregated ZrO2/ SiO2 cluster Germany
(80wt%)
InCoris TZI Zirconium oxide sinter ZrO2+HfO2+Y2O3 ≥99.0%, Y2O3 > 4.5 - ≤ 6.0%, Sirona Dental Systems
ceramic HfO2 ≤ 5% GmbH, Bensheim,
Al2O3 ≤ 0.5%, Other oxides ≤ 0.5% Germany
VITA Suprinity Zirconia-reinforced 56–64% SiO2, 15–21% Li2O, 8-12% ZrO2, 3-8% P2O5, Vita Zahnfabrik H. Rauter
lithium silicate ceramic 1-4% K2O, 0-4% CeO2 GmbH, Bad Säckingen,
Germany
VITA Mark II Feldspar ceramic 56-64% SiO2, 20-23% Al2O3, 6-9% Na2O, 6-8% K2O, VITA Zahnfabrik, Bad
0.3-0.6% CaO, 0-0.1% TiO2 Säckingen, Germany
IPS e.max CAD Lithium disilicate glass- 57-80% SiO2, 11-19% Li2O, 0-13% K2O, 0-11% P2O5, Ivoclar Vivadent, Schaan,
ceramic 0-8% ZrO2, 0-8% ZnO, 0-5% Al2O3, 0-5% MgO, 0-8% Liechtenstein
Colouring oxides
IPS Empress CAD Leucite-reinforced glass 60-65% SiO2, 16-20% Al2O3, 10-14% K2O, 3.5-6.5% Ivoclar Vivadent, Schaan,
ceramic Na2O, 0.5-7% Other oxides, 0.2-1% Pigments Liechtenstein
Abbreviations: Bis-MEPP: 2,2-Bis(4- methacryloxypolyethoxyphenyl) propane; UDMA: urethane dimethacrylate; DMA: dimethacrylate;
Bis-GMA: bisphenol A-glycidyl methacrylate; Bis-EMA: ethoxylated bisphenol A-glycol dimethacrylate; TEGDMA: triethylene glycol
dimethacrylate; SiO2: silicon dioxide; ZrO2: zirconium dioxide; HfO2: hafnium dioxide, Y2O3:yttrium Oxide; Al2O3: aluminium oxide; Li2O:
lithium oxide; P2O5: phosphorus pentoxide, K2O: potassium oxide; CeO2: cerium oxide; CaO: calcium oxide; TiO2: titanium dioxide; ZnO:
zinc oxide; MgO: magnesium oxide; Na2O: sodium oxide.
In addition to these materials, polymer-infiltrated and cost [12,13]. However, the studies which have
ceramics, nano-particulate resin composite and revealed higher survival rates when restorations
zirconia-reinforced lithium silicate ceramics have repaired with repair kits compared to replacement
been recently introduced for CAD/CAM use [5]. of restorations should be considered [14,15]. Today,
It is stated that various factors such as failure on the the repair of ceramic restorations is divided into two
bonding interface, parafunctional habits, internal as direct (oral repair) and indirect repair (extraoral
stress, and inadequate occlusal adjustment can cause repair). Indirect repair is not preferred by clinicians
failure in spite of improvements in CAD/CAM materials because of additional trauma to the restoration
[6]. In addition to these, chipping is shown as the and soft tissue [16]. When resin-based cements
most common cause of failure due to the brittleness are used for a full-ceramic cementation protocol,
properties of some ceramics [7,8]. The fracture rates an intraoral repair system should be preferred on
of restorations are reported approximately 2-16%, account of the difficulty of restoration removal [17].
and 75% in the maxilla [9,10]. These fractures are Repairing a ceramic fracture with composite resin is
classified as cohesive (within repair system or the more conservative, less time consuming, easier and
restorative material), adhesive (between the repair less costly than the complete replacement of the
system and restorative material), and mixed (both restoration [18]. A number of surface conditioning
cohesive and adhesive) [11]. The decision to repair methods are proposed for restorations to increase
or replace the fracture restoration is based on many bond strength with resin composites. However,
factors such as fracture type, material properties there is still no standard protocol for ceramic
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The bond strength of different repair systems
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Original Articles
Table 2. Brand names, chemical compositions and manufacturers of the repair systems used in the study.
Brand Chemical composition Manufacturer
Clearfil Repair
Clearfil SE Bond Primer MDP, HEMA, dimethacrylate monomer, water, Kuraray, Okayama, Japan
photoinitator
Clearfil Porcelain Bond Bisphenol a polyethoxy dimethacrylate, MPS
Activator
Clearfil SE Bond Bond Silanated colloidal silica bisphenol A
CLEARFIL MAJESTY ES-2 0.37-1.5 µm silanated barium glass filler,
prepolymerized organic filler, BisGMA, hydrophobic
aromatic dimethacrylate, dl-camphorquinone,
accelerators, initiators, pigments, 78%wt filled
iGOS Repair
Multi Primer LIQUID Ethanol, thiol compound, silane coupling agent Yamakin CO., LTD., Kochi, Japan
iGOS Bond ethanol, distillated water, methacrylate monomer,
phosphate monomer, carboxylic monomer,
photopolymerization initiator, etc.
iGOS Universal Methacrylate monomer, ceramics cluster filler (1-20
µm), submicron filler (SiO2-ZrO2-Al2O3:200-600 nm ),
spherical nano-filler (SiO2:20 nm), fluoride sustained
release filler (glass:700 nm), inorganic filler content rate
approximately 55 vol%
Abbreviations: MDP: 10-Methacryloyloxydecyl dihydrogen phosphate, HEMA: 2-hydroxyethyl methacrylate, MPS: 3- metacryloxypropyl
trimethoxysilane, Bis-GMA: bisphenol A-glycidyl methacrylate, SiO2: silicon dioxide, ZrO2: zirconium dioxide, Al2O3: aluminium oxide. .
repair systems [19]. Micromechanical retention and and Table 2. One hundred and forty 1.2 mm-thick
chemical bonding procedures are necessary to specimens were prepared from CAD/CAM blocks
increase the bonding strength between the ceramic using a low‑speed diamond saw (Mecatome T180;
and resin composite. Mechanical surface treatments Presi, Grenoble, France) under water cooling (n=20).
provide micromechanical locking by creating micro VITA Suprinity and IPS e.max CAD discs were
roughness at the ceramic surface [20]. Hydrofluoric crystallized (VITA Suprinity: 840°C for 8 minutes, VITA
acid (HF) is the most commonly used chemical Vacumat 40, VITA Zahnfabrik; IPS e.max CAD: 770°C
agent for roughening the porcelain surface. The for 5 min, then 850°C for 10 min, Ivoclar Vivadent AG)
other micromechanical bonding procedures include following the manufacturers’ instructions. InCoris
airborne particle abrasion by using aluminum TZI discs were sintered for 2 hours at a temperature
oxide, tribochemical silica coating, or laser etching starting from 25°C to 1510°C according to the
[21,22]. Sandblasting with Al2O3 particles increase manufacturer’s recommendations. Following the
the efficiency of the porcelain surface and the thermocycling (10,000 thermal cycles between
resin composite-porcelain bond strength. The 5°C-55°C with dwell and transfer times of 20 seconds,
application of silane increases the wettability of the Thermocycler, Esetron Smart Robotechnologies,
ceramic and support the bond between the silica Ankara, Turkey), all specimens were embedded in
(inorganic phase) in the restorative materials and a self-cure acrylic resin (Vertex Self Curing; Vertex-
the methacrylate groups (organic phase) in the resin Dental, Netherlands) and polished with 400, 800,
with Met-methacryloxypropyl trimethoxysilane and 1200 SiC sheets respectively. The specimens of
(MPS) in its content [23-25]. each CAD/CAM materials were randomly divided
The aim of this study was to investigate the micro- into two subgroups to constitute the 14 test groups
shear bond strength (μSBS) of two different repair for repair procedure (n=10).
systems to seven different types of CAD/CAM All tested groups were etched using 40% phosphoric
restorative materials and the failure types after μSBS acid (K-ETCHANT Syringe, Kuraray, Osaka, Japan) for
test. The null hypotheses for this study were: a) There 5 seconds, rinsed under a water spray and dried to
were no differences among the CAD/CAM restorative clean the adhesive surface except for the InCoris TZI
materials and b) between two repair systems. specimens, which Isopropyl alcohol was used for the
same aim. For the roughening procedure, InCoris
2. MATERIALS AND METHODS TZI, Lava Ultimate and Cerasmart specimens were
sandblasted with 50 μm Al2O3 at 2.8 bar pressure
The tested CAD/CAM restorative materials and (Renfert GmbH, Hilzingen, Germany) for 30 seconds
two ceramic repair systems are shown in Table 1 at a distance of 10 mm according to instruments of
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Original Articles Table 3. Results of two-way ANOVA.
Source Type III Sum of Squares df Mean Square F Sig.
Ceramic type 291.424 6 48.571 38.480 .001
Repair system 187.272 1 187.272 148.367 .001
Ceramic type * Repair system 294.759 6 49.126 38.921 .001
Table 4. Mean and SD values for µSBS (MPa).
Clearfil Repair iGOS Repair System
µSBS values µSBS values
(Mean ± SD) (Mean ± SD)
Cerasmart 7.41±0.70A, abc 10.06±0.63B, a
Lava Ultimate 4.66±0.90 A, d
7.16±1.05B, b
InCoris TZI 8.69±1.03A, c 4.76±1.24B, c
VITA Suprinity 8.17±1.34A, bc 12.80±1.73B, d
VITA Mark II 7.29±1.05 A, abc
8.09±0.75A, b
IPS e.max CAD 6.95±1.01A, ab 11.60±1.18B, de
IPS Empress CAD 6.34±1.53 A, a
11.37±1.10B, e
* Capital superscripts correspond 70the same line, lower case superscripts correspond to the same column.
*Significantly different at p <0.05.
Table 5. Failure mode distribution.
Adhesive (%) Cohesive (%) Mixed (%)
Clearfil iGOS Clearfil iGOS Clearfil iGOS
p p p
Repair Repair Repair Repair Repair Kit Repair
Cerasmart 40 10 .303 0 0 - 60 90 .303
Lava Ultimate 50 0 .002* 0 50 .002* 50 50 -
InCoris TZI 0 90 .001* 30 0 .211 70 10 .001*
VITA Suprinity 20 20 - 20 20 - 60 60 -
VITA Mark II 30 30 - 20 0 .114 50 70 .351
IPS e.max CAD 0 0.2 .114 80 50 .138 20 30 .603
IPS Empress CAD 10 0 .292 10 30 .248 80 70 .603
*Significantly different at p <0.001.
repair kit. IPS e.max CAD and VITA Suprinity were 3M ESPE, St Paul, MN, USA) (1200mW/cm2, 430–480
etched 60 sec, VITA Mark II and IPS Empress CAD nm). The specimens treated with iGOS Repair, Multi
were etched 120 sec with 10 % Hydrofluoric acid [26- Primer LIQUID was applied to the specimen surface
28] (Angelus, Londrina, PR, Brazil) and then rinsed and allowed to dry for about 60 seconds. Then iGOS
thoroughly under a water spray for 10 seconds, air- Bond applied and light-cured for 10 seconds, then
dried for 10 seconds according to manufacturer’s the composite resins were polymerized with the
instruction of repair kits. All of the specimens were same curing unit for 20s. After polymerization, the
cleaned by ultrasonic cleaner for 10 min and air‑dried transparent polyvinylchloride cylinder was carefully
for 10 seconds. removed using a scalpel. During the experiment
Following the surface conditioning procedures, a time, all specimens were stored in distilled water at
transparent polyvinylchloride cylinder with a hole 37° C for 3 days.
in the center (2 mm diameter and 2 mm deep) was The μSBS test was performed with a micro-
used for the application of the repair systems to the shear testing device (MOD Dental, Esetron Smart
ceramic surfaces according to the manufacturer’s Robotechnologies, Ankara, Turkey) at 1 mm/
instructions (Fig. 1). The specimens treated with the min crosshead speed using a knife edge‑shaped
Clearfil Repair system, the Clearfil SE Bond Primer and indenter, which was 5 mm in diameter and 1 mm
the Porcelain Bond Activator were mixed in a 1:1 ratio away from the ceramic‑composite interface, placed
and applied for 5 seconds. Then, Clearfil SE Bond was between the composite resin and the CAD/CAM
applied and light-cured for 10 seconds (Elipar S 10, restorative material (Fig. 2). A micro-shear load was
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applied until a fracture occurred, and the value was group repaired with the Clearfil Repair system. There
Original Articles
recorded in Newtons (N). The results were expressed were significant differences between the iGOS and
in megapascal (MPa) values. Following μSBS test, the Clearfil Repair systems for adhesive and cohesive
failure modes of specimens were examined under a failures in the Lava Ultimate group (p<0.001).
stereomicroscope (Leica M320, Leica Microsystems
(Schweiz) AG, Heerbrugg, Switzerland) at × 16 4. DISCUSSION
magnifications and recorded as adhesive, cohesive
or mix failure type. In the current study, the μSBS of two different repair
systems to CAD/CAM restorative materials were
2.1. Statistical analysis tested. Based on the results, the null hypotheses
All statistical analyses were performed using SPSS that types of CAD/CAM restorative materials and
for Windows (12.0, SPSS Inc, Chicago, IL, USA). different repair systems would not affect the bond
The homogeneity of variance and normality of strength were rejected. It was observed that the
distribution for variables were evaluated by Levene success of the repair system depends on the CAD/
and Shapiro Wilk test, respectively. Two-way ANOVA CAM restorative materials.
and Tukey-HSD multiple comparison tests were All CAD/CAM materials tested in this study are
used for statistical analyses. In all tests, p<0.05 was prosthetic restoration materials. Fractures may occur
considered as statistically significant. in these materials during usage. Direct application
of composite resins is a good alternative to extra-
3. RESULTS oral repair techniques because composite resins
are easier to apply, and they are low cost materials.
3.1. μSBS test Their usage would depend on the cause and grade
The two-way ANOVA revealed that the differences of the fractures [29,30]. When repairing the fracture,
among the CAD/CAM restorative material types and a conditioned surface is required to strengthen the
the composite repair material types were statistically adhesion of the repair material to the restoration
significant (p<0.05). There were interactions between surface. It is a challenge for the clinician to choose
surface treatments and the materials (p<0.05) (Table the right option among many repair systems with
3). The mean μSBS test values and differences among different conditioning steps. Surface treatments,
the groups are presented in Table 4. including acid etching, sandblasting (50 μm
Specimens repaired with the iGOS Repair system Al2O3), application of a universal adhesive (silane
showed the highest μSBS values as compared to the containing) and their combinations are commonly
Clearfil Repair system among all tested materials used for intraoral repair or cementation of indirect
except for the InCoris TZI group (p<0.05). The Lava restorations [31-33]. A low viscosity composite may
Ultimate group showed the lowest μSBS values exhibit a larger volumetric shrinkage. At the same
among the materials repaired with the Clearfil Repair time, they have better surface wetting properties
system, while the InCoris TZI group showed the which prevent development of defects during
lowest μSBS test values among the materials repaired repair. Contrarily, resin composites with higher filler
with the iGOS Repair system (p<0.05). Regarding the content, would have a high modulus of elasticity
VITA Mark II group, there was no significant difference which causes a lower volumetric shrinkage and
in the μSBS test values between the Clearfil Repair a higher shrinkage stress at the restoration-resin
system (7.29±1.05 MPa) and the iGOS Repair system interface. This stress would negatively affect the
(8.09±0.75 MPa) (p >0.05). The VITA Suprinity group bond strength. Considering these contradictory
showed the highest μSBS values among the other effects, it is not easy to project on the success of
material groups when repaired with the iGOS Repair a chosen material [34]. In the present study, two
system (p<0.05). The μSBS values were found in the different types of composites were used: 1) Clearfil
InCoris TZI (8.69±1.03), VITA Suprinity (8.17±1.34), Majesty ES-2 is a nanohybrid composite and 2) iGOS
Cerasmart (7.41±0.70) and VITA Mark II (7.29±1.05) Universal is a hybrid composite. The compositions
groups repaired with the Clearfil Repair system, of these composite materials were quite different
respectively, however, there were statistically insigni- from each other. The fact that these materials have
ficant differences among them (p>0.05). different flexural strength may explain the different
μSBS results of the two repair systems [35].
3.2. Stereomicroscopic analysis In the present study, CAD/CAM materials were
The failure mode distribution of different repair selected based on their conditioning concepts and
systems and different CAD/CAM restorative materials compositions. Using the sandblasting method, the
are presented in Table 5. According to the Chi-square surface is blasted with aluminum oxide particles to
Test, significantly different failure types among the roughen and increase the bonding surface of the
tested groups were observed (p<0.001). Adhesive restoration material [36]. Sandblasting reinforces
fractures were mostly obtained in the InCoris TZI wetting with resin, reduces surface tension, and
group repaired with iGOS Repair system while mix increases the total surface area [11]. During the use
failures were mostly obtained in the InCoris TZI of the HF acid for repairing glassy-matrix ceramics,
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the HF acid creates microporosity on the ceramic the VITA Suprinity group repaired with two repair
Original Articles surface to provide mechanical locking with the systems showed no significant difference in bond
resin. Etching of the bonding surface with HF acid strength compared to the IPS e.max CAD subjected
followed by the application of a silane as a coupling to HF etching. We assume that after silanization, the
agent is a commonly used technique for bonding. It zirconia content of VITA Suprinity might become
enhances the bond strength of silica-based ceramics more active for bonding and this may positively
[37]. The HF acid acts on the silicone dioxide present affect the μSBS values of VITA Suprinity. For the iGOS
in the glass phase [38]. The silane monomer has a Repair system, the μSBS values of all groups were
bifunctional group called silanol which interacts with significantly higher compared to the Clearfil repair
the ceramic surface together with a methacrylate system except for the InCoris TZI and the VITA Mark
group that co-polymerizes with the organic matrix II materials. High filler content, homogenization
of composite resins [33]. Silane also increases the technology and diversity of functional monomers
wettability of the ceramic surface and allows the included in the iGOS system might contribute to the
resin to penetrate deeper into its microscopic pores. adhesive strength of this system [35].
This mechanism also reinforces the ceramic-resin The tested InCoris TZI group repaired with
bonding [39]. In the current study, only the specimens Clearfil showed higher bond strength values
in the the InCoris TZI, Lava Ultimate and Cerasmart than the iGOS group. This should be a result of
groups were sandblasted with 50 μm Al2O3 at 2.8 10-methacryloyloxydecyl dihydrogen phosphate
bar pressure, while the VITA Suprinity, VITA Mark II , (MDP) content in the Clearfil SE Bond. MDP
IPS e.max CAD and IPS Empress CAD groups were containing primers form a chemical bond between
treated with HF according to the manufacturer’s resin cements and ceramics [45]. This chemical bond
instructions. However, silane, which is available in is formed between the hydroxyl groups of zirconia
the repair system, was applied to the surface of all and phosphate ester monomers of MDP [46]. Blatz et
samples after surface treatment. Düzyol et al. [40]. al. [47] investigated the effect of Al2O3 sandblasting
investigated the HF etching mechanism of several on bond strength between zirconia ceramics and
restoration materials and they concluded that, self-adhesive resin cements. The sandblasted
alumina crystals in feldspar ceramic, lithium disilicate specimens presented higher bond strength values
crystals in lithium disilicate reinforced ceramic and compared to the groups without sandblasting. The
zirconia fillers and resin matrix in resin nano ceramic bond strength of MDP containing resin cements was
are structural parts of these materials that were also significantly higher than the other groups.
not affected by the acid etching. Lithium disilicate Previous studies show that low bond strength
reinforced ceramic contains a lower percentage values are associated with adhesive failures [48,49].
of glass phase compared to leucite reinforced and Stawarczyk et al. [34] investigated the tensile bond
feldspar ceramic. Therefore, in our study IPS Empress strength values of resin nano ceramic (Lava Ultimate)
CAD and VITA Mark II groups were etched with HF specimens which presented mostly cohesive
acid for 120 seconds, while IPS e.max CAD group was failures. While Üstün et al. [44] reported that the
etched for 60 seconds. Previous studies stated that Lava Ultimate and Vita Enamic specimens showed
lithium disilicate reinforced glass ceramic presented only cohesive failures in their study. In the present
higher microtensile bond strength (μTBS) compared study, hybrid ceramic, the Cerasmart group did not
to feldspatic ceramic and leucite reinforced glass show any cohesive failures. The Lava Ultimate group
ceramic [40-42]. In the current study, there was no repaired with the iGOS Repair system showed higher
significant difference in bond strength values among μSBS values than the Clearfil Repair system which
the VITA Mark II, IPS e.max CAD and the IPS Empress showed no adhesive failure (0%) and the fractures
CAD groups repaired with the Clearfil system. were cohesive (50%) or mixed (50%). Adhesive
However, the VITA Mark II group repaired with iGOS fractures were mostly obtained in the InCoris TZI
showed significantly lower μSBS compared to the groups repaired with the iGOS Repair system which
IPS e.max CAD and IPS Empress CAD groups. Karcı indicates that the bonding interface was weaker than
et al. [43] investigated SBS of different repair systems Clearfil Repair. No adhesive failure was observed in
to IPS e.max CAD and IPS Empress CAD. They found the InCoris TZI material repaired with the Clearfil
that the SBS values of the IPS Empress CAD are higher Repair system. Üstün et al. [44] investigated the
than those for the IPS e.max CAD. On the contrary, in SBS of different repair systems (Ceramic Repair and
the present study, there was no significant difference Clearfil repair) to CAD/CAM restorative materials
between the μSBS values of IPS e.max CAD and IPS (Vita Suprinity, Lava Ultimate, IPS e.max CAD, and
Empress CAD groups. Üstün et al. [44] stated that the Vita Enamic) and revealed complete adhesive failure
Vita Suprinity group presented lower bond strength in the Vita Suprinity and IPS e.max CAD groups
values than the other groups (Vita Enamic, IPS repaired with Clearfil Repair. On the contrary, in the
e.max CAD, Lava Ultimate) subjected to HF etching present study, the VITA Suprinity group repaired
because the zirconia-reinforced lithium silicate with both repair sets presented mixed, adhesive
ceramic group contains 8-12% ZrO2 by weight. and cohesive failures, and the IPS e.max CAD group
However, in the current study, the μSBS values of repaired with the Clearfil Repair system, presented
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80% cohesive failure and 20% mixed failure. 2. The Clearfil Repair system, which contains MDP
Original Articles
This study has several limitations. The clinical aging phosphate monomer, showed higher μSBS values
of restorative materials would change their chemical than iGOS Repair for InCoris TZI.
and mechanical properties. These changes would 3. The μSBS of two different repair systems applied
affect their repairability as well. In the current study, to indirect restorative materials is dependent on the
the specimens were subjected to thermal cycling micro-structure of both tested materials.
before they were repaired, because fractures occur CONFLICT OF INTEREST
during clinical use. The authors declare no conflict of interest.
Future studies should be focused on the effect
of thermocycling after repair process in order to AUTHOR CONTRIBUTIONS
compare changes. Another limitation of this study
is that in order to investigate the bond strength AA: Study and experimental design, data gathering, analysis
between resin and ceramic, the repaired specimens and interpretation of the results, manuscript writing LN: Sample
were only subjected to shear forces. Clinically, preparation, performed the experiment and manuscript writing
repaired restorations are exposed to several intraoral HMK: Study and experimental design, manuscript proofreading
stresses such as tensile, shear, compressive, and AU: Study and experimental design, analysis and interpretation of
oblique forces. Additionally, the bond strength of the results, manuscript proofreading.
the repaired restorations should be investigated
clinically, in order to verify the outcomes of in vitro ACKNOWLEDGMENTS
studies. None.
5. CONCLUSIONS
Within the limitations of this study, the following
conclusions could be drawn:
1. All groups, except for the InCoris TZI group,
repaired with iGOS Repair system showed higher
μSBS than Clearfil Repair system.
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240 Stoma Edu J. 2020;7(4): 233-241 pISSN 2360-2406; eISSN 2502-0285
The bond strength of different repair systems
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Original Articles
Ayșe ATAY
DDS, PhD, Assistant Professor
Department of Prosthodontics
Faculty of Dentistry
Altinbaș University
TR-34147, Bakırkoy/Istanbul, Turkey
CV
Ayşe Atay graduated from Ege University, Faculty of Dentistry, Izmir, Turkey in 2004. She enrolled on her PhD degree in 2006 and
she was awarded her PhD degree by Ege University in 2010. Since 2014, she has been working as an assistant professor at the
Department of Prosthodontics within the Faculty of Dentistry of the Altınbaș University.
Questions
1. Choose the appropriate surface treatment method below to repair fractured
restorations below:
qa. Etching with hydrofluoric acid;
qb. Sandblasting with Al2O3;
qc. Tribochemical silica coating;
qd. All of them.
2. What is the effect of silane application in the surface treatment process?
qa. Increases the wettability of the ceramic;
qb. Creates micro roughness on the ceramic surface;
qc. Cleans the ceramic surface;
qd. Dissolves the glass matrix and the crystalline structure.
3. Which of the following is not one of the advantages of repairing a ceramic fracture
with composite resin?
qa. More conservative;
qb. Less time consuming;
qc. Less costly;
qd. None.
4. According to the results of this study, which restorative material repaired with Clearfil
Repair system showed favorable shear bond strength than repaired with iGOS Repair
system?
qa. Feldspar ceramic;
qb. Lithium disilicate glass-ceramic;
qc. Zirconium oxide sinter ceramic;
qd. Resin nano ceramic.
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