title: Effect of selective enamel etching on clinical performance of CAD/CAM partial ceramic crowns luted with a self-adhesive resin cement Bond durability of self-adhesive composite cements to dentine. The Effects of Different Adhesive Agents on the Shear Bond Strength of a Self-Adhesive Resin Cement Bond strength of adhesive resin cement with different adhesive systems A prospective 15-year evaluation of extensive dentin-enamel-bonded pressed ceramic coverages. In-vitro evaluation of bond strength of four self-etching cements. Correlation between Microleakage and Absolute Marginal Discrepancy in Zirconia Crowns Cemented with Four Resin Luting Cements: An In Vitro Study Four-year clinical evaluation of a self-adhesive luting agent for ceramic inlays Fracture resistance and deflection of pulpless anterior teeth restored with composite or porcelain veneers. Controlled, prospective, randomized, clinical evaluation of partial ceramic crowns inserted with RelyX Unicem with or without selective enamel etching. Results after 2 years Dentin bond strengths of two ceramic inlay systems after cementation with three different techniques and one bonding system. A practice-based research network on the survival of ceramic inlay/onlay restorations.
abstract: Objectives This study was conducted to evaluate a self-adhesive resin luting cement [ RelyX Unicem 3MESPE – RXU ] for  luting partial ceramic crowns ( PCCs )  with and without selective enamel etching in a prospect i ve , r and omized clinical trial . Material s and methods Thirty-four patients had received the intended treatment . Two PCCs ( Vita Mark II ; Cerec 3D ; Sirona ) had been placed in a split-mouth design : one with RXU without enamel etching ( RXU ) , the other with RXU with selective enamel etching ( RXU + E ) . Restorations were evaluated at baseline ( BL ) and after 12 , 24 , and 36 months ( USPHS criteria ) . For statistical analysis , the Chi-square test was applied ( α = 0.05 ) . Clinical survival of all restorations ( n = 68 ) after 3 years was determined using Kaplan – Meier analysis . Results Twenty three patients ( 12 male/11 female ) were available for clinical evaluation after 3 years . 19 RXU-PCCs were placed in molars , four in premolars , 18 RXU + E – PCCs in molars , five in premolars . Concerning clinical changes , no significant differences were found between luting strategies RXU/RXU + E at all recalls . Statistically significant changes over time were observed for marginal adaptation and marginal discoloration between BL and 36 m for RXU and RXU + E. For RXU + E , postoperative hypersensitivities decreased significantly from BL ( n = 6 ) to 36 m ( n = 0 ) . Of the 68 restorations originally included , eight RXU and four RXU + E restorations failed . At 3 years , Kaplan – Meier survival  of RXU was 72.9 % , that of RXU + E 87.6 % . Survival rates were not statistically significant different . Conclusions Although clinical survival of RXU + E is slightly better at 3 years , restorations of both groups perform similar with respect to clinical changes over time as evaluated by modified USPHS criteria . Clinical relevance The self-adhesive resin cement RXU can be used in conjunction with selective enamel etching , because survival rates of PCCs in the RXU + E group were not lower but , as a trend , even better than without enamel etching OBJECTIVES Clinical ly , the most easy-to-use composite cements are the so-called self-adhesive composite cements ( SAC 's ) . Hardly any data is however today available on the long-term bonding effectiveness of such luting composites . The purpose of this study was to evaluate the bond durability of different composite cements used to lute feldspathic ceramic blocks onto dentine . METHODS Four SAC 's ( Clearfil SA Cement , Kuraray ; G-CEM , GC ; SmartCem2 , Dentsply ; Unicem 3 M ESPE ) , one ' self-etch ' ( Clearfil Esthetic Cement , Kuraray ) and one ' etch- and -rinse ' ( Variolink ll , Ivoclar-Vivadent ) multi-step composite cement were used to lute feldspathic ceramic blocks ( Vita Mark II , Vita ) onto dentine surfaces . Teeth were distributed r and omly in 24 experimental groups according to two different surface-preparation techniques ( ' SMEAR-COVERED ' versus ' SMEAR-FREE ' ) and storage conditions ( ' IMMEDIATE ' versus ' AGED ' ) . Failure patterns were evaluated with a stereomicroscope , and afterwards imaged using Feg-SEM . Two additional specimens were processed for cement-dentine interfacial analysis using TEM . RESULTS A linear mixed effects statistical model revealed significant differences for the variables ' composite cement ' , ' surface preparation ' and ' ageing ' . All self-adhesive composite cements , except Unicem ( 3 M ESPE ) , did bond less favourably to fractured dentine . TEM revealed an ultra-structurally different interaction of the composite cements with ' SMEAR-COVERED ' and ' SMEAR-FREE ' dentine . CONCLUSION All SAC 's suffered most when luted to ' SMEAR-FREE ' ( fractured ) dentine , fortunately of no clinical relevance and most likely due to enhanced water sorption through the open tubules . When luted to ' SMEAR-COVERED ' dentine , all SACs appeared equally effective and durable as the ' etch- and -rinse ' and ' self-etch ' multi-step composite cements . Solely the SAC SmartCem2 ( Dentsply ) appeared clearly less favourable and consistent Purpose To compare the clinical success of a self-adhesive resin cement used in combination with different adhesive bonding systems with that of a conventional dual-cure resin cement . Methods The study was performed with 136 freshly extracted molars embedded in acrylic resin blocks and 136 IPS e.max Press discs . Teeth and discs were r and omly divided into four equal groups and cemented together using either RelyX ARC ( ARC ) , RelyX Unicem ( Unicem ) , RelyX Unicem+Adper-Prompt L-pop ( L-pop ) , or RelyX and Unicem+Total-etch ( Total-etch ) . Shear bond strength measurements were obtained before and after thermocycling . Following bond testing , the surfaces of one sample per subgroup ( thermocycled and non-thermocycled ) , were assessed using scanning electron microscopy ( SEM ) . Results Among the non-thermocylced subgroups , ARC exhibited the highest bond strength values , followed by Total Etch , Unicem and L-pop . ARC also exhibited the highest bond strength values among the thermocycled subgroups , followed by Unicem , Total-etch , and L-pop . SEM analysis clearly revealed the negative effects of thermo-cycling on the mechanical properties of adhesive agents . Conclusions RelyX Unicem may be preferable in many cases because of its simplified application and reduced technique-sensitivity Background To assess the immediate bond strength of a dual-cure adhesive resin cement to the hybridized dentin with different bonding systems . Material and Methods Fifty-six healthy human molars were r and omly divided into 7 groups ( n=8 ) . After 3 longitudinal sections , the central cuts were included in PVC matrix and were su bmi tted to dentin hybridization according to the groups : G1 - etch & rinse system with 3-step ( Apder ™ Scotchbond ™ Multi- Purpose , 3 M ESPE ) , G2 - etch & rinse system with 3-step ( Optibond ™ FL , Kerr ) , G3 - etch & rinse system with 3-step ( All-Bond 3 ® , Bisco ) , G4 - etch & rinse simplified system ( Adper ™ Single Bond 2 , 3 M ESPE ) , G5 - self-etching system with one step ( Bond Force , Tokuyama ) , G6 - universal system in moist dentin ( Single Bond Universal , 3 M ESPE ) , G7 - universal system in dry dentin ( Single Bond Universal , 3 M ESPE ) . Then all groups received the cementing of a self-adhesive resin cement cylinder ( Duo-link , Bisco ) made from a polypropylene matrix . In the evaluation of bond strength , the sample s were subjected to the microshear test and evaluated according to the fracture pattern by optical microscopy . Results The Kruskal-Wallis test suggests a statistically significant difference between groups ( p=0,039 ) , and Tukey for multiple comparisons , indicating a statistically significant difference between G3 and G4 ( p<0.05 ) . It was verified high prevalence of adhesive failures , followed by mixed failure and cohesive in dentin . Conclusions The technique and the system used to dentin hybridization are able to affect the immediate bond strength of resin cement dual adhesive . Key words : Adhesion , adhesive resin cement , adhesive systems , microshear OBJECTIVES The purpose of this study was to investigate the durability of extensive dentin-enamel-bonded posterior ceramic coverages  in a 15 years follow-up . METHODS All extensive dentin-enamel-bonded posterior partial and complete all-ceramic coverages placed during the period November 1992-December 1998 were included . In 121 patients , 252 coverages ( IPS Empress ) were placed . The adhesive bonding to dentin and enamel was performed with three 3-step and one 2-step etch and rinse bonding . In 106 restorations the classic Syntac was used in combination with the dual-cured resin composite Variolink . The other restorations were luted with the chemically cured resin composite Bisfil 2B and bonded with 3-step etch and rinse systems , classic Gluma ( 37 ) , Allbond 2 ( 57 ) , Syntac ( 32 ) or the 2-step etch and rinse system , One step ( 20 ) . The ceramics were evaluated yearly by modified USPHS criteria during 15 years . RESULTS Postoperative sensitivity was registered in 4 patients during bite forces lasting for 2 - 4 weeks . Fifty-five of 228 coverages ( 24.1 % ) failed . The mean observation period of the acceptable coverages was 12.6 years ( range 11 - 15 years ) . The main reasons for failure were lost restorations ( 18 ) , ceramic fracture ( 16 ) , and secondary caries ( 11 ) . Significant differences in failure rate were observed between the dentin bonding agents but not between the two luting agents . Ceramic  coverages placed on non-vital teeth failed in 39 % and on vital teeth in 20.9 % ( p=0.014 ) . Logistic regression indicated three significant predictors for failure of the coverages : gender and parafunctional habits of the patient and non-vitality of the tooth . SIGNIFICANCE The technique investigated showed advantages like less destruction of healthy tissue , and avoiding of endodontic treatment and /or deep cervical placement of restoration margins to obtain retention Indirect restorations need to be attached with adhesive luting agents to prevent them from becoming dislodged and provide adequate marginal sealing . The aim of this study was to evaluate bond strength to dentin of self-etching resin cements . MATERIAL S AND METHODS 75 flat dentin surfaces were r and omly distributed among 5 groups , according to cements used ; Group 1 : RelyxU100 ( 3M/ESPE ) , Group 2 : Bis Cem ( Bisco ) , Group 3 : Max Cem ( Kerr ) , Group 4 : SeT PP ( SDI ) and Group 5 : Relyx ARC ( 3M/ESPE ) , control . Ceramic test cylinders ( IPS Empress 2 / Ivoclar-Vivadent ) 4.1 mm across were prepared and attached to the dentin surfaces using the different cements . A constant 25N load was applied for 1 minute and they were light-polymerized . Following storage for 24 hours at 100 % humidity and 37 ° C , the specimens were tested for bond strength under shear strain in an Instron testing machine at a crosshead speed of 1 mm/minute ; at 7 , 14 and 21 days . Data were analyzed by ANOVA and Tukey 's test . There were significant differences between material s ( p < 0.0001 ) , but not between times or material /time interaction . RelyXARC ( Control Group ) had the highest bond strength ( 15.52 MPa ) . Among the self-etching cements , the best behavior was found for Relyx U100 ( 10.80MPa ) , followed by BisCem ( 6.36 MPa ) , MaxCem ( 5.45 MPa ) and SeTPP ( 3.17 MPa ) . The bond strength of the self-adhesive cements evaluated was lower than that for resin cements which require previous treatment of the dental substrate ( control group ) . This should be taken into account during clinical selection , in particular for tooth preparations with poor retention Objectives . To evaluate microleakage and absolute marginal discrepancy ( AMD ) and to assess correlation between AMD and microleakage with four resin luting cements . Material and Methods . 20 extracted human third molars were prepared for full-coverage crowns . 20 zirconia copings were made ( LAVA , 3 M ESPE ) and cemented . Specimens were r and omly allocated for each used type of cement into 4 groups , RelyX ® ( Rx ) , Multilink ® ( Mk ) , PANAVIA 2.1 ® ( P ) , and Maxcem ® ( Mx ) and immersed in 10 % safranin for 72 hours . 20x magnification lenses were used to observe microleakage areas ( μm2 ) and images software was used to measure AMD areas ( μm ) . Discrepancy and microleakage between the cements were compared with one-way ANOVA test with confidence interval of 95 % . Results . Rx Group showed microleakage has lowest value and AMD has highest value . P Group showed microleakage has the highest value and Mk Group presented AMD has lowest value . There were no significative differences between the cements . There were no linear correlations between microleakage and AMD ; however a complex regression statistical model obtained allowed formulating an association between both variables ( microleakage = AMD0,896 ) . Conclusions . No significative differences were found among 4 types of cements . No linear correlations between AMD and microleakage were found . Clinical Significance . AMD is not easily related to microleakage . Characteristics of cements are fundamental to decreasing of microleakage values Objectives The aim of this r and omized controlled clinical trial was to evaluate the 4-year clinical performance of a self-adhesive resin cement , RelyX Unicem ( 3 M ESPE ) , used for cementation of ceramic inlays . In addition , the influence of selectively acid-etching enamel prior to luting on the clinical performance of the restorations was assessed . Methods Sixty-two IPS Empress 2 inlays/onlays were placed in 31 patients by two experienced clinicians . The restorations were luted with RelyX Unicem with ( = experimental group : E ) or without ( = control group : NE ) prior enamel etching with phosphoric acid . At baseline , 6 months , and 1 , 2 , and 4 years after placement , the restorations were assessed by two calibrated investigators using modified USPHS criteria . Ten selected sample s of each group were investigated under SEM regarding morphological changes at the cement – inlay interface . Results The recall rate at 4 years was 97 % . Two restorations ( 1 E , 1 NE ) were lost , and one ( E ) had to be replaced due to inlay and tooth fracture result ing in a survival rate of 95 % . No significant differences between the experimental and control group were noticed regarding all criteria ( McNemar , p < 0.05 ) . An obvious deterioration in marginal integrity was observed after 4 years as only 5 % ( E = 7 % ; NE = 3 % ) of the restorations exhibited an excellent marginal adaptation . In 90 % of the restorations small , still clinical ly acceptable marginal deficiencies were observed . SEM of the luting gap showed an increased wear of the RelyX Unicem cement over the 4-year period . Conclusions The self-adhesive luting cement RelyX Unicem can be recommended for bonding of ceramic inlays/onlays . Additional selective enamel etching does not improve the clinical performance of the restorations within the 4-year period . Clinical relevance The self-adhesive resin composite RelyX Unicem showed acceptable clinical performance after 4 years of clinical service INTRODUCTION The aim of this in vitro study was to evaluate the influence that resin composite and porcelain veneer restorations , associated or not to fiber post placement , have on fracture resistance and deflection of pulpless anterior teeth .  METHODS One hundred twenty freshly extracted human maxillary central incisors were selected . Teeth were r and omly divided into 7 experimental groups ( veneer preparation/resin composite veneer placement/endodontic therapy and resin composite veneer placement/endodontic therapy , fiber post and resin composite veneer placement/porcelain veneer placement/endodontic therapy and porcelain veneer placement/endodontic therapy , fiber post and porcelain veneer placement ) and a control group ( n = 15 ) . Specimens were loaded to fracture recording crown deflection , and data were statistically analyzed . RESULTS Veneer preparations did not significantly influence fracture resistance of incisors . On the contrary , veneer preparation significantly increased specimen deflection values .  Fiber posts seemed to significantly increase mean maximum load values for endodontically treated teeth restored with either composite or porcelain veneers . CONCLUSIONS A fiber post restoration can be suggested when endodontic treatment is associated with veneer restoration . Veneer restorations seem to be an optimal choice also for endodontically treated teeth Among the material s used for luting indirect restorations , growing interest has been directed towards the use of self-adhesive resin cements . The aim of this prospect i ve r and omized controlled clinical trial was to evaluate the clinical performance of the self-adhesive resin cement RelyX Unicem ( RXU ) for luting partial ceramic crowns ( PCCs ) . In addition , the influence of selective enamel etching prior to luting ( RXU+E ) was assessed . Two-year results are reported . Thirty-four patients ( 68 PCCs ) had originally received the intended treatment at baseline ( BL ) . Twenty-nine patients ( 14 male , 15 female ) with a total of 58 PCCs participated in the 2-year recall . In each patient , one PCC had been placed with RXU , one PCC with RXU+E. Restorations were evaluated at BL and 24 months after placement using modified United States Public Health Service criteria for postoperative hypersensitivity , anatomic form , marginal adaptation , marginal discoloration , surface texture and recurrent caries . Additionally , the “ percentage failure ” within the 2-year recall period for all restorations ( n = 68 ) was calculated according to ADA Program Guidelines . Target value for acceptability of each procedure was < 5 % failure within 24 m. For statistical analysis of the data , the chi-square test was applied ( α = 0.05 ) . The median patient age was 41 years ( 24–59 years ) . Median PBI was 8 % ( 5–10 % ) . Twenty-two RXU PCCs were placed in molars , seven in premolars . Twenty-one RXU+E PCCs were placed in molars , eight in premolars . Statistically significant changes were observed for marginal adaptation ( MA ) and marginal discoloration ( MD ) between BL and 2 years but not between the two groups ( RXU , RXU+E ) . Percentage of alfa values at BL for MA ( RXU , 97 % and RXU+E , 100 % ) and for MD ( RXU , 97 % and RXU+E , 97 % ) decreased to RXU , 14 % and RXU+E , 28 % for MA and to RXU , 50 % and RXU+E , 59 % for MD after 24 months . Within the observation period , three failures were recorded with RXU ( 5.1 % failure ) , one failure was recorded for RXU+E ( 1.7 % failure ) , but a significant influence of selective enamel etching on failure could not be verified . Although the results of the present study reveal a slight tendency for more favourable results if selective enamel etching is applied prior to insertion of ceramic PCCs with a self-adhesive luting material , longer-term evaluation is needed to confirm this . Additional selective enamel etching with a self-adhesive luting material does not considerably improve clinical performance of the restorations within the observation period reported , neither does it impose a hazard with respect to postoperative hypersensitivity STATEMENT OF PROBLEM Cementation of inlay restoration is critical . Because of its high organic content , dentin is a less favorable substrate for bonding than enamel . Therefore it is important to improve dentin adhesion when placing ceramic inlay restorations . PURPOSE The purpose of this study was to compare the dentin bond strengths of 2 different ceramic inlay systems after cementation with 3 different techniques and 1 bonding system . MATERIAL AND METHODS One hundred twenty freshly extracted caries- and restoration-free molar teeth used in this study were stored in saline solution at room temperature . St and ardized Class I preparations were made in all teeth . Each preparation had a length of 6 mm , a width of 3 mm , a depth of 2 mm , and 6-degree convergence of the walls . Teeth were r and omly assigned to 2 groups of 60 each to evaluate the bonding of 2 ceramic systems , Ceramco II ( Group I ) and IPS Empress 2 ( Group II ) , to dentin . Each of the 2 groups were further divided into 3 cementation technique groups of 20 each ( Group I A , B , and C and Group II A , B , and C ) . Groups I A and B and Groups II A and B used dentin bonding agent ( DBA ) Clearfil Liner Bond 2V , and resin cement ( Panavia F ) . Groups I C and II C served as control groups and used Panavia F without the dentin-bonding agent . In Groups I A and II A , the DBA was applied immediately after the completion of the preparations ( D-DBA ) . Impressions were then made , and the ceramic inlays were fabricated according to the manufacturers ' guidelines . In Groups I B and II B the DBA was applied just before luting the inlay restorations ( I-DBA ) . In Groups I C and II C , no bonding agent was used before the cementation of the inlay restorations ( No DBA ) . Cementation procedures followed a st and ard protocol . After cementation , specimens were stored in distilled water at 37 degrees C for 24 hours . The teeth were sectioned both mesial-distally and buccal-lingually along their long axis into three 1.2 x 1.2 mm wide |-shaped sections . The specimens were then subjected to microtensile testing at a crosshead speed of 1 mm/min , and the maximum load at fracture ( in kilograms ) was recorded . Two-way analysis of variance and Tukey honestly significant difference tests were used to evaluate the results ( P<.05 ) . Scanning electron microscopy analysis was used to examine the details of the bonding interface . The fractured surfaces were observed with a stereomicroscope at original magnification x22 to identify the mode of fracture . RESULTS Although no significant difference was found among the 2 ceramic systems with regard to dentin bond strengths ( P>.05 ) , the difference between the cementation techniques was found to be significant ( P<.001 ) . Comparison among techniques showed that the dentin bond strength in the D-DBA technique had a significantly higher mean ( 40.27 + /- 8.55 Kg ) than the I-DBA ( 30.20 + /- 6.78 Kg ) and No DBA techniques ( 32.43 + /- 8.58 Kg ) . As a result of scanning electron microscopy analysis , a distinct and thicker hybrid zone with more , and longer resin tags were found in specimens treated with the D-DBA technique than with the other 2 techniques . Most failures ( 353 of 360 ) were adhesive in nature at the bonding resin/dentin interface . Only 7 specimens showed cohesive failure within the bonding resin . CONCLUSION Within the limitations of this in vitro study , the cementation of the ceramic inlays tested with the D-DBA technique used result ed in higher bond strengths to dentin OBJECTIVE To evaluate prospect ively the longevity of  ceramic inlay/onlay restorations  placed in a web-based practice -based research network and to investigate risk factors associated with restoration failures . MATERIAL S AND METHODS Data were collected by a practice -based research network called Ceramic Success Analysis ( CSA ) . 5791 inlay/onlay ceramic restorations were placed in 5523 patients by 167 dentists between 1994 and 2014 in their dental practice s. For each restoration specific information related to the tooth , procedures and material s used were recorded . Annual failure rates ( AFRs ) were calculated and variables associated with failure were assessed by a multivariate Cox-regression analysis with shared frailty . RESULTS The mean observation time was 3 years ( maximum 15 years ) of clinical service , and AFRs at 3 and 10 years follow up were calculated as 1.0 % and 1.6 % . Restorations with cervical outline in dentin showed a 78 % higher risk for failure compared to restorations with margins in enamel . The presence of a liner or base of glass-ionomer cement result ed in a risk for failure twice as large as that of restorations without liner or base material . Restorations performed with simplified adhesive systems ( 2-step etch- and -rinse and 1-step self-etch ) presented a risk of failure 142 % higher than restorations performed with adhesives with bonding resin as a separate step ( 3-step etch- and -rinse and 2-step self-etch ) . 220 failures were recorded and the most predominant reason for failure was fracture of the restoration or tooth ( 44.5 % ) . CONCLUSIONS Ceramic inlay/onlay restorations made from several glass ceramic material s and applied by a large number of dentists showed a good survival . Deep cervical cavity outline , presence of a glass ionomer lining cement , and use of simplified adhesive systems were risk factors for survival
target: According to this review , the 3-step adhesive systems were the best performing and still are the gold st and ard for the cementing of indirect restorations .
  In addition , it can be concluded that self-etched adhesive systems reduce the time spent in clinical practice , however at the interface level they behave as permeable membranes more susceptible to degradation
background: New technologies are changing the therapeutical options to do indirect restorations and new adhesive systems are continuously introduced to be used by clinicians .
  Different interactions between restorations , adhesive systems components , enamel and dentin require having criteria based on the selection of the adhesive system , ensuring the longevity of the restorations and the preservation of the biological remnant .
  The adhesion force to the dental tissue is one of the indicatives of the behavior of the adhesive systems and influences the behavior of the treatments with direct and indirect restorations .
  The objective of this search was to find the adhesive systems with the best results in terms of the adhesion strength of indirect restorations  on the dental tissues .