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Item Effectiveness of universal adhesive bonding agents on the shear bond strength to lithium disilicate ceramics(2015) AlRabiah, Mohammed A.; Platt, Jeffery A.; Levon, John A.; Brown, David T.; Chu, Tien-Min Gabriel; Bottino, Marco C.Background: All-ceramic restorations have excellent esthetic outcomes compared with other restorative materials. Lithium disilicate is classified as one of many silica-based all-ceramic materials. Currently, companies have provided single-step adhesives, known as universal adhesives, compatible with different restorative materials including lithium disilicate. Many studies have reported greater bond strengths when using a silane to treat the lithium disilicate before applying the bonding agent. Moreover, few studies were published comparing the bond strength when using the universal adhesive alone. Purpose: The objective of this study was to evaluate and compare shear bond strength of three universal adhesives to lithium disilicate ceramic restorative material. Materials and Methods: Three universal adhesive bonding agents were selected from commercially available adhesives. 408 IPS e.max CAD ceramic discs were processed, fired, and etched for 20s. The specimens were divided into six groups. The first three groups used the universal adhesive directly. The remaining three groups were treated with silane. Then, a composite resin cylinder was placed on top of the adhesive using a bonding jig. Each group was subdivided into four equal subgroups (n = 17), subjected to different aging simulation procedures: 24 h, one month with 5000 thermocycles, two months with 5000 cycles, and three months with 5000 cycles. Then, specimens were debonded using shear force by a universal testing machine (MTS). Results: Shear bond strength was greater with silane than without silane (p < 0.0001), regardless of the levels of adhesive or time. Shear bond strength was significantly greater at 24h and 1m than at 2m (p < 0.0001) or 3m (p < 0.0001) regardless of the adhesive or the presence of silane. Debonded specimens were examined under a stereomicroscope at X45 magnification to evaluate the fracture pattern. SEM was used to prove the results were considered as mixed failure. Conclusion: The optimal bonds to lithium disilicate are achieved by application of silane prior to application of a universal adhesive. Although the constituent silane in the universal adhesive was not effective in optimizing the resin to ceramic bond, silane should always be applied to lithium disilicate prior to bonding.Item Effects of Various Thicknesses on Load to Fracture of Posterior CAD/CAM Lithium Disilicate Glass Ceramic Crowns Subjected to Cyclic Fatigue(2015) Al-Angari, Nadia; Platt, Jeffrey A.; Bottino, Marco C.; Haug, Steven P.; Brown, David T.; Levon, John A.Background: New glass ceramics and Computer-Aided Design/Computer Assisted Manufacture (CAD/CAM) have become common aspects of modern dentistry. The use of posterior ceramic crowns with a high level of esthetics, fabricated using the CAD/CAM technology is a current treatment modality. Several materials have been used to fabricate these crowns, including lithium disilicate glass-ceramics, which have not been fully investigated in the literature. Objective: to investigate the load to fracture of lithium disilicate glass ceramic posterior crowns fabricated by CAD/CAM technology with different material thicknesses adhesively cemented on epoxy resin. Methods: Four groups of different ceramic thicknesses (0.5 mm, 1 mm, 1.5 mm, and 2 mm) were fabricated by milling CAD/CAM lithium disilicate IPS emax CAD blocks. A total of 68 posterior crowns were surface treated and luted with a resin adhesive cement on an epoxy resin model. Samples were fatigued then loaded to fracture using a universal testing machine to test the fracture strength. Statistical comparisons between various crown thicknesses were performed using one-way ANOVA followed by Fisher's Protected Least Significant Differences. Results: There was a significant difference in the load-to-fracture (N) value for all comparisons of the four thickness groups (p < 0.0001), except 2 mm vs. 1.5 mm (p = 0.325). The mean load-to-fracture (N) was significantly higher for 2 mm than for 1 mm or 0.5 mm. Additionally, the mean load-to-fracture was significantly higher for 1.5 mm than for 1 mm or 0.5 mm. Furthermore, the mean load-to-fracture was significantly higher for 1 mm than for 0.5 mm. Conclusion: Within the limitation of this study, it is advisable for clinical applications to consider a crown thickness of 1.5 mm or greater of milled lithium disilicate for posterior single teeth.Item Fatigue failure load of lithium disilicate restorations cemented on a chairside titanium-base(2017) Kaweewongprasert, Peerapat; Morton, Dean; Levon, John A.; Phasuk, Kamolphob; Bottino, Marco C.PURPOSE: To evaluate the fatigue failure load of distinct lithium disilicate restoration designs cemented on a chairside titanium-base (VariobaseTM for CEREC®, Straumann® LLC, USA) for restoring anterior implant restoration. MATERIALS AND METHODS: Left maxillary incisor restoration was virtually designed in 3 groups (n=10; CTD: lithium disilicate crowns cemented on custom-milled titanium abutments; VMLD: monolithic full-contour lithium disilicate crowns cemented on titanium-base; and VCLD: lithium disilicate crowns cemented on lithium disilicate customized anatomic structures then cemented on titanium-base). The titanium-base was air-abraded with aluminum oxide particles, 50 µm at 2 bars. Subsequently the titanium-base was steamed, air-dried and a thin coat of silane (Monobond Plus, Ivoclar Vivadent®, USA). All ceramic components were surface treated with hydrofluoric acid etching gel, follow by silanized, and bonded with resin cement (Multilink Automix, Ivoclar Vivadent®, USA). Specimens were fatigued at 20 Hz, starting with a load of 100 N (×5000 cycles), followed by stepwise loading up to 1400 N at a maximum of 30,000 cycles each. The failure loads, number of cycles, and fracture analysis were recorded. Data were statistically analyzed using one-way ANOVA followed by pair-wise comparisons (p < 0.05). Kaplan-Meier survival plots and Weibull survival analyses were reported. RESULT: For catastrophic fatigue failure load and total number of cycles for failure, VMLD (1260 N, 175231 cycles) was significantly higher than VCLD (1080 N, 139965 cycles) and CDT (1000 N, 133185 cycles). VMLD had higher Weibull modulus (11.6), demonstrating higher structural reliability. CONCLUSIONS: VMLD performed the best fatigue behavior when compared with the two other groups.