Preheated Composite Resin Used As A Luting Agent For Indirect Restoration Effect On Bond Strength and Resin Dentin Interfaces
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CLINICAL RESEARCH
Preheated composite resin used used as a luting agent for indirect restorations: effects on bond eff bond strength and and resin– dentin interfaces Marcelo Goulart, DDS, MSc
Barbara Borges Veleda, DDS, MSc
Deisi Damin, DDS, MSc
Glaucia Maria Bovi Ambrosano, Agr.Eng, MSc, PhD Department of Social Dentistry, Piracicaba Dental School, State University of Campinas,
Fabio Herrmann Coelho de Souza, DDS, MSc, PhD
Maria Carolina Guilherme Erhardt, DDS, MSc, PhD
Correspondence to: Dr Maria Carolina Guilherme Erhardt
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Abstract
min. The characteristics of the adhesive
Purpose: The aim of this study was to Purpose:
interfaces were observed under scan scan
evaluate the effect of preheating com com
posite resins used as luting agents for
indirect restorations on microtensile
and the Tukey test ( α When luting 2 mm restorations, Results: When Results:
terfaces.
ex Material and methods: methods: Fifty sound ex
or at room temperature, achieved signifi signifi
tracted third molars were used. Ten
experimental groups were formed with
At this depth, Venus did not differ from
three different luting agents: one resin
restorations, only preheated Venus pre pre
posite resins were tested both at room
RelyX ARC. Preheating the composite
temperature and when preheated to
resin resulted in thinner luting interfaces,
with a more intimate interaction between
luting agent and an d adhesive layer.
resin restorations, previously made on
Conclusion: Preheating composite resin Conclusion: Preheating
cylindrical molds. Adhesive and luting
for luting procedures may not improve
procedures were done under simulated
pulpal pressure. After luting, the teeth
duce material viscosity and improve res res
toration setting.
sectional area of 1 mm2 at the bonded
(Int J Esthet Dent 2018;13:86–97)
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CLINICAL RESEARCH
Introduction
Heating composite resin was report report ed to be a way of achieving a higher
Indirect restorations such as inlays and
onlays have been widely used in the
composite
past. Although they have shown good
Cerutti11 observed that preheated com com
1,2 most re re ported failures are related to restoration
posite resins showed a similar degree of
margins. After 11 years of placement,
It has also been reported in the literature
that this heating strategy reduces com com
rect inlays.3
posite resin viscosity,12,13 which could
presented cement wear in this period.
benefit the luting procedure. With regard
Adhesive luted restorations differ from
to temperature aggression, preheated
direct fillings due to the presence of a
composite resin presented a low tem tem
luting agent on the margin. Therefore,
perature rise in the pulpal chamber and
marginal defects on indirect restorations
was shown to be a safe clinical proced proced
are mainly associated with the luting
ure even on vital teeth.
agent.
resins.10 Acquaviva
and
Despite all the evidence, luting indi indi
Among all luting materials, resin ce ce
rect restorations with preheated com com
ment is the standard adhesive luting
posite resin has not yet been tested and
agent for indirect restorations. Yet, the
compared to resin cement. Thus, the
presence of light passing through the
aim of this in vitro study study was to evaluate
restoration to activate the luting agent
the effect of preheating composite resin
is a major concern.
used as a luting agent for indirect res res
resin cements are most commonly pre pre
torations on microtensile bond strength
cements. Composite resin has been suggested as an alternative material to improve restoration performance. 6
Materials and methods
In a recent study, similar results were reported after 10 years of follow up for composite resin indirect restorations lut lut
man third molars were used in this study
ventional composite resin at room tem tem
perature.7 Composite
resin may perform
better than resin cement on restoration
ter extraction. The teeth were obtained
margins in the long term due to more
under informed consent, with protocols
inorganic load filling. This higher filler
that were approved by the local ethics
content on the composite resin gives
the material better mechanical proper proper
All the teeth had a flat occlusal dentin
ties.8 Moreover, composite resin does
surface that was exposed by removing
not contain chemical activators, which
the occlusal enamel with a diamond saw
88 THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY SPRING 2018
GOULART ET AL
layer,, all dentin surfaces layer sur faces were wet grind grind
ed with 600 grit SiC papers for 30 s (Lab (Lab
roots removed using a diamond saw to
perform a cut 2 mm below the cemento cemento
plied according to instructions. All ad ad
To simulate pulpal pressure, the teeth
hesive procedures took place in a room
were connected with a 18 gauge stain stain
with a container of distilled water deliver deliver
The teeth
ures in this study. Light irradiance was
were bonded to the device with cyano cyano
2.
Luting procedures were randomly
processed according to a table of ran ran
sure before the adhesive procedures.
dom numbers. After the dentin and res res
Ten experimental groups were defined
toration surfaces were ready, a stand stand
to test three different materials (one resin
placed on the restoration. Then, the res res
toration was pressed over dentin using
two temperatures (room temperature
16 Excess
Fifty
composite
resin
discs
were
cement was removed with a brush, and
made by layering increments of a nano nano
on top of the restoration, on the buccal
and lingual surfaces. For the preheated
groups, the composite resin and restor restor
light activated for 20 s with a LED curing
The time of the restoration setting with
were placed above a polyester sheet,
the static load was reduced to 30 s to
and a glass slab was pressed on top of
avoid temperature loss at the time of ac ac tivation.
the last increment. One side of the res res
After storage in distilled water, the
teeth
were
sectioned
perpendicular
to the luting interface into slabs and
then applied for 60 s and air dried (Pros (Pros
bonded area a rea of approximately 1 mm2
was applied and light activated for 20 s.
only dentin were selected for each ex ex
The materials and methods used for
perimental group. The beams were in in
the adhesive and luting procedures were
applied according to the manufacturers’
cyanoacrylate adhesive and stressed to
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CLINICAL RESEARCH
Table 1
Adhesive materials, composition, and application techniques used
Material and
Composition
manufacturer
(Batch No.)
Mode of application
Adper Scotch Scotch
HEMA, polyalkenoic
bond Multiuse
acid polymer, water
Primer – 3M ESPE
Adper Scotch Scotch
1. Apply adhesive
bond Multiuse
amines, and photoinitia photoinitia
2. Light cure for 10 s
Adhesive – 3M
ESPE
Silane Prosil –
Ethanol, water and
1. Apply for 60 s
FGM
2. Air dry
Resin cement RelyX ARC –
camphorquinone,
2. Hand mix for 10 s
3M ESPE
3. Apply at luting surface
Nanohybrid resin
PEGDMA, TEGDMA,
shade
Microhybrid resin
composite Venus
barium glass and
A2 shade
Nanohybrid
Urethandimethacrylate
resin composite
barium glass,
ytterbium trifluoride and
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GOULART ET AL
Table 2
Temperature Depth
Resin
Venus 2 mm
RelyX ARC Venus
RelyX ARC
Room
64°C
*Differs from RelyX ARC at same depth. P P
failure in tension at a crosshead speed
examined in a scanning electron mi mi
failure was measured with a precision
celerating voltage of 20 kV in order to
of 0.01 mm with a digital caliper (Star (Star
observe the morphology of the bonded
interfaces.
test (α
Results
Failure modes were evaluated after testing under a stereomicroscope (EMZ,
classified as adhesive, mixed, or cohe cohe
perimental groups are displayed in Table 2. ANOVA ANOVA detected significant signific ant dif dif
ferences between groups. When luting
P P
ditional resin–dentin bonded slabs from
or at room temperature, achieved sig sig
each experimental group were used for
(P
evaluation. The slabs were polished with
not different from the resin cement, al al
waterproof papers of decreasing abra abra
siveness up to 1200 grit. After polish polish
preheated Venus presented significantly
P P
RelyX ARC, Venus at room temperature, tempera ture,
dium hypochlorite for 2 min. Prepared
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CLINICAL RESEARCH
Table 3
Source
Pr > F
Resin
0.0008
comparing preheated composites, there was no difference between both res res
Temp
Depth
Resin*temp
(P
0.0013
strength was influenced by the compos compos Resin*depth
Temp*depth
ite resin factor ((P P ture and depth did not influence bond strength values ((P P
Resin*temp*depth
shows the failure modes of all the experi experi mental groups. No statistical difference was found for fracture patterns.
Table 4
Distribution of failure modes after microtensile bond strength test
Fracture pattern Temperature
Depth
Resin
Venus 2 mm
RelyX ARC
Adhesive
Mixed
Cohesive
Room Venus
RelyX ARC Venus
2 mm Venus
P = = 0.2110
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G6 – RelyX (4 mm)
Fig 1
G4 – Venus 64° (2 mm)
Adhesive interfaces of Venus composite resin, at room temperature and preheated.
G8 – Z250 XT (2 mm)
Fig 3
G8 – Z250 XT (4 mm)
Adhesive interfaces of groups at room temperature.
G2 – Venus (2 mm)
Fig 2
G7 – Venus (4 mm)
G5– Z250 XT 64° (4 mm)
93 THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY SPRING 2018
CLINICAL RESEARCH
Regarding resin–dentin bonded inter inter
faces, different characteristics for each
ite resin showed similar or higher re re
experimental group could be observed
sults compared to resin cement at both
under SEM examination. Resin cement
temperatures and depths. Temperature
presented thin films of luting material
that could easily be identified between dentin and restoration adhesive layers
factorial analysis. The SEM evaluation showed different adhesive interface
characteristics. Preheated composite
terial ranged around 30 µm.
resin showed a different interaction with
The effects of preheating compos compos ite resin were clearly noticed on resin–
the adhesive compared to the other ma ma terials.
dentin bonded interfaces. A reduction
Other studies have shown negative
of the entire interface thickness (ad (ad
effects of light attenuation with different
materials such as composite resin and
due to the composite resin viscosity de de
ceramics.17,18 It was reported that com com
crease. While the thickness of unheated
posite resin presented less light attenua attenua
groups ranged around 60 to 80 µm µ m (Ve (Ve
tion compared to ceramic. Regardless
of the restorative material, light attenua attenua
heated materials showed thicknesses of
tion causes a reduction in the degree of
conversion of the luting agent. This re re
duction is associated with poor mechan mechan
ical properties of the material. Therefore,
Although it resulted in a clear viscos viscos
luting agent selection for indirect restor restor
ity reduction, preheating did not allow
ations is generally affected by the mater mater
for an accurate observation of the ma ma
ial activation mode. However, a clinical
terial thickness inside the luting film. A
study that followed resin indirect restor restor
more intimate interaction caused by the
the composite resin layer was observed
for 10 years did not find any difference
when heating was employed. Due to
between the two luting agents. 7
this behavior, a clear identification identifica tion of the adhesive layer and the luting material
Despite many in vitro reports reports of light attenuation and its influence on me me
on the interface was not possible. Fig Fig
chanical properties, the present study
ures 2 and 3 show this different heating
did not show this behavior, since res res
behavior.
toration height could not be related to a decrease in bond strength. Although it was expected that groups luted with
Discussion
composite resin at room temperature would show that light attenuation affect a ffect
The aim of this study was to evaluate
ed final bond strength, this trend was not
the effect of preheating composite resin
observed. Our results therefore corrobo corrobo
used as a luting agent for indirect res res
rate with those found in the previously
mentioned clinical study. This could be
94 THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY SPRING 2018
GOULART ET AL
explained by a proper degree of con con
According to this specification, type II
version achieved with the light activation
cements must not exceed a film thick thick
protocol followed for all experimental
groups. The protocol used in this study
dence of the clinical implications of this
does not seem to overestimate light
value for an indirect restoration, since
2
most studies are conducted for crowns. Composite resins present higher film
lingual surfaces is easily carried out in
thicknesses compared to resin cements,
clinical situations. Also, composite resin
but preheating was shown to reduce
the viscosity of some composite resins
Com Com
to comparable values that are attained
posite resins are comparable to dentin
with resin cements. In a previous study study,,
regarding light transmittance,20 thus the
a preheated microhybrid composite res res
restoration design used in this study did
not seem to increase clinically possible
luting irradiation.
ness compared to that under room tem tem
Clinically, the use of preheated com com
perature. Therefore, preheating may
posite resins may be a challenge be be
be important to avoid a poor restoration
cause of the shorter working time. To
setting.
benefit from heating features,21,22 the
Composite resin composition plays a
composite resin must still be heated at
major role in the viscosity of the mater mater
the moment of light activation. Accord Accord
ial. Among other factors, filler and mon mon
ing to Daronch et al, 23 a temperature
omer composition are directly related
to mechanical properties and viscos viscos
ing the heating device. Therefore, luting
ity of composite resin.26,27 Regarding
or restorative procedures using preheat preheat
filler load, higher filled composite res res
ed composite resin must be performed
ins present higher viscosity. Moreover,
carefully so that the material is quickly
light activated after leaving the heating
viscosity. Composite resins with bigger
device. In this study, this temperature
loss was avoided by reducing the restor restor ation setting time to 30 s. Also, heating
and nanohybrid composite resins tend to present higher viscosity than micro micro
effects were clearly noticed in the SEM
hybrid ones. This behavior was con con
images.
firmed for both composite resins under
Film thickness is a feature that was
SEM evaluation. Despite other factors
considered in the luting agent selec selec
that may influence viscosity, microhy microhy
tion. Nevertheless, there is no clear
brid composite resin presented shal shal
evidence in the literature of a specific
lower luting films.
correct thickness for luting inlays and on on
Apart from all the evidence for the
lays. The American Dental Association
possibility of using composite resin as a
Specification No. 8, which established
luting agent for indirect restorations, fur fur
is commonly used as a reference.
benefits of this material. Longitudinal
95 THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY SPRING 2018
CLINICAL RESEARCH
clinical studies might show whether
Conclusion
composite resins can perform better than resin cements, mainly in terms of
Preheating of composite resin for luting
marginal defects.
though it could be used to reduce ma ma terial viscosity and improve restoration setting.
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