Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestrasse 70, 80336, Munich, Germany.
Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Clin Oral Investig. 2019 Feb;23(2):529-538. doi: 10.1007/s00784-018-2461-7. Epub 2018 Apr 27.
Because of their industrially standardized process of manufacturing, CAD/CAM resin composites show a high degree of conversion, making a reliable bond difficult to achieve.
The purpose of this experiment was to investigate the tensile bond strength (TBS) of luting composite to CAD/CAM resin composite materials as influenced by air abrasion and pretreatment strategies.
The treatment factors of the present study were (1) brand of the CAD/CAM resin composite (Brilliant Crios [Coltene/Whaledent], Cerasmart [GC Europe], Shofu Block HC [Shofu], and Lava Ultimate [3M]); (2) air abrasion vs. no air abrasion; and (3) pretreatment using a silane primer (Clearfil Ceramic Primer, Kuraray) vs. a resin primer (One Coat 7 Universal, Coltene/Whaledent). Subsequently, luting composite (DuoCem, Coltene/Whaledent) was polymerized onto the substrate surface using a mold. For each combination of the levels of the three treatment factors (4 (materials) × 2 (air abrasion vs. no air abrasion; resin) × 2 (primer vs. silane primer)), n = 15, specimens were prepared. After 24 h of water storage at 37 °C and 5000 thermo-cycles (5/55 °C), TBS was measured and failure types were examined. The resulting data was analyzed using Kaplan-Meier estimates of the cumulative failure distribution function with Breslow-Gehan tests and non-parametric ANOVA (Kruskal-Wallis test) followed by the multiple pairwise Mann-Whitney U test with α-error adjustment using the Benjamini-Hochberg procedure and chi-square test (p < 0.05).
The additional air abrasion step increased TBS values and lowered failure rates. Specimens pretreated using a resin primer showed significantly higher TBS and lower failure rates than those pretreated using a silane primer. The highest failure rates were observed for groups pretreated with a silane primer. Within the Shofu Block HC group, all specimens without air abrasion and pretreatment with a silane primer debonded during the aging procedure.
Before fixation of CAD/CAM resin composites, the restorations should be air abraded and pretreated using a resin primer containing methyl-methacrylate to successfully bond to the luting composite. The pretreatment of the CAD/CAM resin composite using merely a silane primer results in deficient adhesion.
For a reliable bond of CAD/CAM resin composites to the luting composite, air abrasion and a special pretreatment strategy are necessary in order to achieve promising long-term results.
由于其工业化标准制造工艺，CAD/CAM 树脂复合材料表现出高度的转化率，使得可靠的结合难以实现。
本实验旨在研究空气喷砂和预处理策略对 CAD/CAM 树脂复合材料的粘固复合材拉伸结合强度（TBS）的影响。
本研究的处理因素为（1）CAD/CAM 树脂复合材料的品牌（Brilliant Crios [Coltene/Whaledent]、Cerasmart [GC Europe]、Shofu Block HC [Shofu]和 Lava Ultimate [3M]）；（2）空气喷砂与无空气喷砂；（3）使用硅烷底漆（Clearfil Ceramic Primer，Kuraray）预处理与使用树脂底漆（One Coat 7 Universal，Coltene/Whaledent）预处理。随后，使用模具将粘固复合材料（DuoCem，Coltene/Whaledent）聚合到基底表面上。对于三个处理因素（4（材料）×2（空气喷砂与无空气喷砂；树脂）×2（底漆 vs. 硅烷底漆））水平的每个组合，n=15，制备样本。在 37°C 和 5000 热循环（5/55°C）下储存 24 小时后，测量 TBS 并检查失效类型。使用 Breslow-Gehan 检验和非参数 ANOVA（Kruskal-Wallis 检验）对Kaplan-Meier 累积失效分布函数进行数据分析，然后使用 Benjamini-Hochberg 程序和卡方检验（p<0.05）进行调整的多重两两曼-惠特尼 U 检验。
额外的空气喷砂步骤增加了 TBS 值并降低了失效率。用树脂底漆预处理的标本显示出明显更高的 TBS 和更低的失效率，而用硅烷底漆预处理的标本则显示出明显更高的 TBS 和更低的失效率。用硅烷底漆预处理的标本的失效率最高。在 Shofu Block HC 组中，所有未经空气喷砂预处理且用硅烷底漆预处理的标本在老化过程中均脱粘。
在固定 CAD/CAM 树脂复合材料之前，应进行空气喷砂并用含有甲基丙烯酸甲酯的树脂底漆预处理，以成功地将其与粘固复合材料结合。仅仅使用硅烷底漆预处理 CAD/CAM 树脂复合材料会导致附着力不足。
为了实现 CAD/CAM 树脂复合材料与粘固复合材料的可靠结合，需要进行空气喷砂和特殊的预处理策略，以获得有前途的长期效果。
