Article_5_2_4
ORTHODONTICS
BONDING ORTHODONTIC RESIN CEMENT TO ZIRCONIUM OXIDE UNDER
Original Article
ORTHODONTICS LOAD AND THERMOCYCLING EFFECT
Hind S. Hussein1a, Nader Abdulhameed1b, Chiayi Shen1c, Calogero Dolce2d, Jean-François Roulet1e*
1
Department of Restorative Dental Sciences, College of Dentistry, University of Florida
2
Department of Orthodontics, College of Dentistry, University of Florida
a,
BDS, Courtesy Clinical Assistant Professor
b
BDS, MS, PhD Student, Clinical Assistant Professor
c
PhD, Associate Professor
d
DDS, PhD, Professor
e
Dr med dent, Dr hc, Professor, Director of Center for Dental Biomaterials
ABSTRACT DOI: 10.25241/stomaeduj.2018.5(2).art.4
Purpose: Evaluate the microshear bond strength (µSBS) of orthodontic resin cement to OPEN ACCESS This is an
monolithic zirconium oxide ceramic (MZ) under orthodontic load (OL) and thermocycling Open Access article under the CC
(TC) effect. BY-NC 4.0 license.
Peer-Reviewed Article
Materials and Methods: Glazed MZ blocks (Zenostar, Ivoclar Vivadent) were tested after
air abrasion with 30-µm silica coated aluminum oxide (Al2O3) particles (CoJet, 3M ESPE). The Citation: Hussein HS, Abdulhameed N,
Shen C, Dolce C, Roulet J-F. Bonding of
specimens were randomly divided into 4 groups (n = 15): G1, OL with TC; G2, OL without orthodontic resin cement to zirconium
TC; G3 no OL with TC; and G4, no OL, no TC (control). Orthodontic cement cylinders (Heliosit oxide under load and thermocycling.
Stoma Edu J. 2018;5(2):102-108.
Orthodontic, Ivoclar Vivadent) were bonded to the primed samples (Monobond Plus,
Ivoclar Vivadent) using the Ultradent SBS system and light cured (SmartLite Max, Dentsply Academic Editor: Diana Dudea,
DDS, PhD, Professor, “Iuliu Hațieganu”
Sirona, 1400 mW/cm2, 40 s). G1 and G2 were subjected to 70 ± 15 N load perpendicular to University of Medicine and Pharmacy
Cluj-Napoca, Cluj-Napoca, Romania
the cylinder axis, G1 and G3 were thermo-cycled (5000 cycles 5-55°C, 90 s/cycle). G2 and
G4 were stored in distilled water at 37 ± 1°C. The specimens were subjected to µSBS test Received: May 28, 2018
Revised: June 06, 2018
(crosshead speed 0.5 mm/min). Data were analyzed using two-way ANOVA, and one-way Acccepted: June 11, 2018
ANOVA and Tukey test (HSD). Published: June 12, 2018
Results: Two-way ANOVA for µSBS values (MPa) showed significant (p = 0.0004) load effects, *Corresponding author: Professor
but not thermal effect (p = 0.2455) with significant load/thermocycling interactions (p < Jean-François Roulet, DMD, PhD, Dr hc
Center for Dental Biomaterials, College
0.0001). The ranking of the single groups by Tukey test (α = 0.05) showed that G1 exhibited of Dentistry, University of Florida 1395
the highest µSBS (8.4 ± 2.8 MPa), G4 (6.3 ± 1.1 MPa) and G2 (5.8 ± 1.1 MPa) as a group was Center Drive, Room D9-26, Gainesville,
FL 32608 Gainesville, FL 32608, USA Tel:
second, and G2 and G3 (4.7 ± 1.1 MPa) as a group was the lowest. +1 352 273 5850; Fax: +1 352 846 1643,
e-mail: jroulet@dental.ufl.edu
Conclusion: G1, which is the closest to clinical reality, yielded the best results.
Keywords: orthodontics, dental materials, orthodontic resin cement, monolithic zirconium oxide Copyright: © 2018 the Editorial Coun-
cil for the Stomatology Edu Journal.
ceramic, microshear bond strength test.
1. Introduction restorations [6]. Previous studies have reported that
Due to the patients’ increased esthetic demands and the life expectancy of (3Y-TZP) zirconium oxide when
the development of technology in dental materials, compared to PFM FDPs for posterior indication, is
porcelain fused to metal (PFM) crowns and bridges are shorter because of the delamination and chipping
being replaced by glass based ceramic materials and of veneering ceramic; to overcome this problem, the
monolithic Zirconium oxide (MZ) [1]; they are more monolithic zirconium oxide (MZ) was introduced to the
esthetic, biocompatible, resistant to wear, show low dental market [1,2,4,7].
thermal conductivity, and are color stable [2]. However, Full contour MZ FDPs are produced using CAD/CAM
despite these advantages, the brittle nature of these technologies. The restorations are milled from blocks
materials restricts their use [3]. which can be used either glazed or polished for better
Therefore, there is a need for new materials which have esthetic results [8]. Although polishing may provide
the same esthetic properties as glass based all ceramic sufficient esthetic appearance by decreasing the
materials and a strong framework like PFM for fixed surface roughness, technicians like to glaze the ZrO2
dental prosthesis (FDPs). The introduction of zirconium surface to improve the esthetic properties. With this
oxide fulfilled these requirements [4]. The advantages process, the glass will infiltrate the zirconium oxide [9].
of zirconium oxide include high fracture resistance and Since the number of adult patients who have been
high flexural strength (> 1000 MPa), which allowed for seeking orthodontic treatment is increasing [9], it
thinner restorations. Furthermore the material can be means that the orthodontist will sometimes apply
stained which allows better esthetic results [5]. These orthodontic brackets on dental restorations rather than
properties make it a very good candidate for aesthetic on enamel. In a clinical situation, the orthodontist may
FDPs. The tetragonal zirconia polycrystals (TZP), not know the composition of all the ceramic crowns.
especially 3 mol % Y2O3 stabilized zirconia (3Y-TZP) Since different ceramics require different bonding
has been used as a material for dental and medical procedures and the lack of bonding protocols for
102 Stoma Edu J. 2018;5(2): 102-108 http://www.stomaeduj.com
BONDING ORTHODONTIC RESIN CEMENT TO ZIRCONIUM OXIDE UNDER
ORTHODONTICS LOAD AND THERMOCYCLING EFFECT
these new materials, these situations may lead to early
Original Article
Table 1. Types, brands, manufacturers and chemical compositions of the
debonding of orthodontic brackets [4]. Furthermore, in material used in this study.
orthodontics the goal is not a maximum bond strength,
but one that is adequate to withstand orthodontic Type and
Manufacturer Chemical composition
Brand
forces. Finally, the bond should be reversible i.e. it
should be easy to remove brackets without damaging Zirconium dioxide (ZrO2 + HfO2
the enamel or the restored teeth. + Y2O3) > 99.0%, yttrium oxide
Zenostar Wieland, Ivoclar (Y2O3) 4.5 ≤ 6.0%
Currently, there are several studies about the different Vivadent Hafnium oxide (HfO2) ≤ 5.0 %,
surface conditioning protocols for orthodontic bonding aluminum oxide (Al2O3) + other
to porcelain materials. They enhance the adhesion oxides ≤ 1.0 %
either by mechanical conditioning such as “roughness by Glaze spray
IPS e.max Isobutane 30-60%, propan-2-ol
airborne particle abrasion” or by chemical conditioning Ceram 25-40%
such as the use of hydrofluoric acid etch of glass-based Acratray Henry Schein;
Poly Methyl methacrylate
ceramics to increase the bond strength and/or silane Acrylic Powder Melville NY,
(PMMA), calcium carbonate,
titanium dioxide, benzoyl
coupling agents or oxidic primers which change the (blue) USA
Peroxide
wettability of the surface, or by combination of both
Acrylic Liquid Methyl methacrylate (MMA),
mechanical and chemical surface treatments [10-12]. (Self cure)
Henry Schein
benzophenone, hydroquinone
Although there is increased use for MZ crowns in dental
3M ESPE; St
practice, there is not enough information available about CoJet Sand
Paul, MN, USA
30-μm Al2O3 SiO2
how to bond orthodontic brackets on MZ [13]. The most
Ivoclar Ethanol, 3-trimethoxysilylpropyl
commonly method used to evaluate the performance Monobond Vivadent; methacrylate, methacrylate
of orthodontic bonding systems and the bonding Plus Schaan, phosphoric acid ester, disulfide
technique is by measuring shear bond strength [14]. Liechtenstein methacrylate
Doing this, one should consider the effect of orthodontic Bis-GMA 50-100%
Heliosit
forces applied and the stress induced by water storage Orthodontic
urethane dimethacrylate 10
Ivoclar Vivadent < 20%
and thermocycling on the bond strength. This should Adhesive
1,10-decandiol dimethacrylate
be simulated in vitro as an accelerated ageing process 10 < 20%
[13]. In shear bond strength testing, the ideal direction
Orthodontic ORTHO
of pull is parallel to the loading interface. It has been wire TECHNOLOGY
SS Straight Lengths 0.14.
recognized that the direction of the debonding force
Dentsply GAC
will affect the results [15]. In clinical orthodontic practice, Orthodontic
international,
brackets Stainless Steel.
bonding the brackets and placement of arch wire might INC Bohemia,
be done in the same visit. Hence, force could be applied NY, USA
to the bracket within the first hour after bonding and
then sintered in a furnace at 1530°C (Sintramat S1 High
regardless of the relatively low magnitude of the force,
Temperature Furnace, Ivoclar Vivadent) with a heating
it could have an adverse effect on the bond strength.
rate of 8°C/min and a holding time of two hours.
It was reported that the polymerization of adhesives
All the specimens were glazed with (IPS e.max
should quickly reach a minimum value to enable the
Ceram glaze spray, Ivoclar Vivadent) according to the
adhesive to resist bonding failure when tying in initial
manufacturer’s directions (770°C). The glazing material
arch wires [16].
was applied in an even layer on the specimen in the
The objective of this study was to evaluate the thermo
usual manner and then all the specimens were fired
cycling effect accompanied by orthodontic force on
according to the manufacturer’s direction in a furnace
the micro shear bonding strength of orthodontic resin
(Programat EP 5000, Ivoclar Vivadent). After completion
cement on glazed monolithic zirconium oxide surface
of the firing process the samples were removed from
conditioned by air abrasion with silica coated alumina
the furnace and allowed to cool to room temperature
particles.
in a place protected from draft.
The following null hypotheses were tested: 1) The
All specimens were then embedded in autopolymer-
thermo cycling (TC) does not influence the shear bond
izing acrylic resin (powder and liquid, Acratray Blue,
strength, 2) The orthodontic load does not influence
Henry Schein, Melville, NY, USA). First, the specimens
the shear bond strength, and 3) The orthodontic load
were held in place on a smooth surface with a piece of
with TC does not influence the shear bond strength.
two-sided adhesive tape. Then, powder and liquid of
acrylic resin was mixed (1:3) and poured into the molds
to produce cylinders measuring 2.5 cm in diameter and
2. Material and methods
2.3 cm in length (Ultradent Products, South Jordan, UT,
The types, brands, manufacturers and chemical
USA). After autopolymerization started, the mold was
composition of the material used in this study are listed
placed in a container with cold water to decrease the
in Table 1.
polymerization temperature.
After polymerization, the cylinders were removed from
2.1. Specimen Preparation
the mold and the two-sided adhesive tape was removed.
One monolithic zirconium oxide (MZ) material was
The specimen surfaces were then cleaned with ethanol
tested in this study (Zenostar, Ivoclar Vivadent,
(Table 1). The cylinders were ground with 120-grit silicon
Schaan, Liechtenstein). The specimens were received
carbide abrasive paper under running water for about 1
in nonsintered blocks. They were cut into squares
min to ensure a parallel surface to the bottom surface of
approximately (9 mm × 9 mm × 4 mm). They were
the clamp into which the cylinders were placed during
Stomatology Edu Journal 103
BONDING ORTHODONTIC RESIN CEMENT TO ZIRCONIUM OXIDE UNDER
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bonding.
Original Article The specimens (N = 60), were randomly divided in two
subgroups. Half of the specimens with orthodontic load
(n = 30) and the other half without orthodontic load (n
= 30). The orthodontic load and the non-orthodontic
load specimens were further randomly divided into two
subgroups: thermo cycling (TC) group and non-thermo
cycling (non-TC) group (n = 15 per group) (Fig. 1).
2.2. Surface Conditioning Methods
All the specimen’s surfaces were conditioned using
air abrasion with an intraoral air-abrasion device
(Microetcher, Danville Engineering, San Ramon, CA,
USA) with 30 μm silica-coated Al2O3 (CoJet Sand, 3M
ESPE, St Paul, MN, USA), perpendicular to the surface
from approximately 10 mm for 20 s in circling motions
at 2.8 bar. After air abrasion, the specimen surfaces
were air blown to remove the remnants of the powder.
2.3. Bonding Procedures
Specimen surfaces were coated with a thin layer of
Universal Primer (Monobond Plus, Ivoclar Vivadent) that
Figure 1. Experimental sequence, MZ= Monolithic Zirconium oxide ce-
was left for 60 seconds to allow it to react, and then the ramic, TC= Thermocycling effect.
remaining excess was removed with a strong stream of
air. Each specimen was fixed to a bonding clamp with
a special mold (Ultradent Shear Bond Test, Ultradent
Products, Inc., South Jordan, UT, USA) to assure flat
substrate surfaces and to standardize the diameter (2.3
mm) of the resin composite. Orthodontic resin (Heliosit
Orthodontic, Ivoclar Vivadent) was applied to the surface
using the bonding mold. Composite was applied in the
mold and light cured (SmartLite Max, Dentsply Sirona,
York, PA, USA, 1400 mW/cm2, 40 s) (Fig. 2). All specimens
were stored in distilled water at 37 ± 1°C.
As next step, orthodontic brackets were bonded to
the acrylic next to the embedded specimens of the
load groups. The position was selected to apply a
force of approximately 70 ± 15 g (0.69 ± 0.14 N) with Figure 2. The Pencil line is tangent to the composite cylinder and it is 0.5
mm higher than the position of the bracket on the both side of MZ, in order
an orthodontic wire (SS 0.14) (Fig. 3) to the bonded
to provide 70 ± 15 g (0.69 ± 0.14 N) load force by the orthodontic wire.
composite cylinders. The force was measured by using a
Dontrix gauge (TP Orthodontics, Inc., La Porte, IN, USA).
The orthodontic load group and the non-orthodontic
load group were further randomly divided into two
subgroups (n = 15): the thermo cycling (TC) group and
the non-TC group (Fig. 1). Before testing the microshear
bond strength all the specimens of the TC group were
thermocycled in a Chewing Simulator device (CS-4SD
Mechatronic GmbH, Feldkirchen, Westerham, Germany)
for 5000 cycles between 5°C and 55°C with a dwell time of
30 seconds with the mechanical load component of the
machine turned off. At the same time, all the specimens
of the non-TC group were stored in distilled water at 37
± 1°C. The position of the brackets to be bonded to the
resin block is marked on both sides of the composite/MZ Figure 3. Top view showing the final design after adding orthodontic
sample. The specimens were subjected to µSBS test using wire to composite cylinder.
an universal machine (Instron 1125, Norwood, MA, USA, 0.05) for shear used to determine significant differences
Fig. 4) (crosshead speed 0.5 mm/min). between the group dependent on the variable with
and without application of load and/or TC.
2.4. Statistical Analysis
Means and standard deviations of the shear bond
strength were calculated for all groups [9]. Microshear 3. Results
bond strength data (MPa) were submitted to a two- Two-way ANOVA for µSBS values (MPa) showed highly
way ANOVA (SAS 9.4). Multiple comparisons were made significant (p = 0.0004) effects, however highly signifi-
using the Tukey´s Studentized Range (HSD) Test (α = cant load/thermocycling interactions were found (Tab.
104 Stoma Edu J. 2018;5(2): 102-108 http://www.stomaeduj.com
BONDING ORTHODONTIC RESIN CEMENT TO ZIRCONIUM OXIDE UNDER
ORTHODONTICS LOAD AND THERMOCYCLING EFFECT
2). Therefore, no main effects could be shown. The sub-
Original Article
sequent one-way ANOVA and the Tukey test (α = 0.05)
showed that thermal cycling with load (G1) had the great-
est shear bond strength (8.4 ± 2.8 MPa) while the thermal
cycling alone (G3) had the least shear bond strength (4.7
± 1.1 MPa) among the groups. Comparing the results of
µSBS values for the adhesive system with and without
the application of TC eliminates the effect of the load (G3,
G4) and showed that there was significant difference be-
tween them and there was a significant difference with
load (G1, G2). The result shows a nonsignificant reduction
in µSBS values between the load without TC effect (G2)
and TC without load (G3) (Fig. 5).
Figure 4. Sample loaded in universal Instron machine.
4. Discussion
The first and third null hypotheses had been rejected,
the second one had been accepted.
The conditioning technique used in this study (17),
gritblasting with CoJet (Al2O3 silica coated sand) was
selected for the following reasons: glass based ceramics
can be etched with Hydrofluoric acid (HF) to achieve
an excellent micromechanical surface topography for
bonding. On the other hand, ZrO cannot be etched
with HF at room temperature at all. Sandblasting with
CoJet works well on glass-based ceramics as well. Since
the orthodontists do not know which ceramic has
Figure 5. Means and standard deviations of μSBS values between the TC been used, with the method used they are on the safe
and non-TC group with or without the orthodontic load. Bars connected
with a line are in the same statistical group (Tukey test, α=0.05).
side. It would be the protocol of choice in the clinical
routine [17].
Due to increased esthetics most MZ FDPs are glazed or
stained, according to the study of Canigur et al. [4] “the
CoJet yields higher bond strength values. The CoJet cre-
ates micro retentive sites by increasing surface area and
roughness” [18-20] “silica coated particles not only rough-
Figure 6. The principle of CoJet treatment: the silica coated alumina par-
ticles create micro roughness of the surface due to the kinetic energy and
en the surface, they also have a chemical effect: because of
leave silica embedded inside the surface, so it can react chemically with a blasting pressure, the embedded silica and alumina par-
primer (Silane) [21]. ticles can then chemically react with the silane coupling
agent“ (Fig. 6) [21]. “The improved chemical bonding with
Table 2. Two-way ANOVA for µSBS values (MPa). Note that the 2-way silane coupling agents in this approach is advocated to be
ANOVA showed highly significant differences (Model p<0.0001). However the key factor for a higher resin bond strength.”
there were higly significant interactions (Load x Thermal). Since the orthodontist does not know the details of
Mean F the fabrication process of the crown where a bracket
Source DF Anova SS Pr > F
Square Value should be bonded to, it is better to consider the ZrO
Model 3 110.1178850 36.7059617 13.25 <.0001 surfaces were all glazed. With the gritblasting the glaze
Error 56 155.1204133 2.7700074 may be partially or totally removed but using CoJet. A
Corrected silica layer is deposited regardless of the composition
59 265.2382983
Total of the underlying surface, thus allowing the use of
Load 1 38.86540167 38.86540167 14.03 0.0004 Silane as a primer.
Thermal 1 3.81528167 3.81528167 1.38 0.2455
Spontaneous debonding of brackets is one of the most
common clinical problems in fixed orthodontic therapy.
Load
+Thermal
1 67.43720167 67.43720167 24.35 <.0001 There are two major interfaces that can be subjected to
deboning: the enamel or restorative material/adhesive
Table 3. Means and Standard deviations of the 4 tested groups. Same interface and the adhesive/bracket interface [22] . In this
letters in the Tukey Grouping column mean no statistically significant dif- study, we tested the restorative material (ZrO)/adhesive
ference. interface and it was decided not to use brackets for the
following reasons: The shear bond strength between
TRET N Mean STD Tukey Grouping orthodontic cement and the ceramic surface was the
TC _Load (G1) 15 8.4320 2.76480 A
only topic of interest. If we had used brackets we would
have had to deal with the bracket-cement interface as
Control (G4) 15 6.3180 1.09754 B well, which was investigated in the past abundantly
Load (G2) 15 5.8073 1.06452 B C [23-25]. Furthermore, it was necessary to eliminate
TC (G3) 15 4.7020 1.04792 C possible confounding factors such as geometry, mesh
design of the bracket base, or bracket material, all of
Stomatology Edu Journal 105
BONDING ORTHODONTIC RESIN CEMENT TO ZIRCONIUM OXIDE UNDER
ORTHODONTICS LOAD AND THERMOCYCLING EFFECT
which may influence the test results [23-25]. Therefore, bond strength of bis-GMA resin composites, regardless
Original Article we opted for a shear bond test which is the closest to of air abrasion or silica coating and silanization. Hence,
the clinical reality. We assume that the main reason for because no long-term aging was performed in this
bracket failure is shear. The shear bond strength test study, the results should be carefully and critically
was performed with an orthodontic resin composite evaluated, considering that bonding in orthodontics
cylinder in order to eliminate tilting moments as much is semi-permanent. However, at least 24-month water
as possible. However, we understand elastic and plastic storage should be preferred for orthodontic bond
deformation of the cylinder may have some negative strength testing [32], since it is usually the average
effects on the shear bond strength measured. We are period for complete orthodontic treatment with fixed
well aware that in orthodontic treatment brackets appliances, and significant decreases may be expected
transmit forces to the teeth in all directions, however under such prolonged aging conditions compared to
unexpected debondings usually occur under shear. The shorter durations of only a few days to several months
brackets used in this study were used to apply shear [30,33]. The bond strength is affected by aging only
forces to the bonded cylinders and were attached to when a mechanical pre-treatment is not applied prior
the resin-embedding material (Fig. 3). to an MDP-containing primer [34]. Wegner and Kern
Thermocycling is a standard procedure for accelerated [25] also showed that the bond strength of an MDP-
ageing in bond strength tests in vitro. In this study, all containing resin composite did not change significantly
the specimens of the TC group were thermocycled in after aging [25]. For this reason, the use of universal
a chewing simulator device for 5000 cycles between primers containing methacrylate phosphoric acids and
5°C and 55°C with a dwell time of 30 seconds with the silane should be preferred after air-abrasion protocols.
mechanical load component of the machine turned The results (Fig. 5) were not as anticipated. All samples
off. At the same time, all the specimens of the non- of the present study were stored in water for the same
TC group were stored in distilled water at 37 ± 1°C. time (2 weeks); the only difference is that some groups
Extensive water storage and thermal cycling seem to be were subjected to additional stress (Load or TC) of the
important parameters to simulate intraoral conditions interface before being subjected to shear stress to
and to stress bonding interfaces. Literature data show failure. One could assume that additional stress would
that thermocycling had a much higher impact on the weaken the interface. This only happened for TC, which
durability of the resin bond strength to zirconia than confirms the trend in other studies. However direct
did water storage at a constant temperature alone [26]. comparisons are difficult or problematic, because of
Loading the samples represented the clinical reality. the different methods used in different studies. The Kiel
In clinical orthodontic practice, bonding of brackets group has extensively looked into the bond strength
and placement of the arch wires can be done in the of composites to ceramics, especially zirconium oxide
same visit, particularly after rebonding of debonded ceramic. However they use tensile strength as a testing
brackets. Hence, force could be applied to the bracket method and very long water storage (up to 2 years)
within the first hour after bonding. This force could and high numbers of TC (37,500) [35-38]. As a general
affect polymerization of the orthodontic adhesive and trend they found for most adhesive techniques that
subsequently its bond strength. water storage with or without TC has a negative effect
The force magnitude used for orthodontic tooth on bonded interfaces.
movements varies depending on the type of movement There are a few studies that use shear or microshear
[16]. In this study, 70 ± 15 g (0.69 ± 0.14 N) was applied. bond strength. When looking at the bond strength
This force is considered the optimal orthodontic force. of surfaces that have been silicatized (Rocatec, CoJet
In the clinical situation the average force transmitted to or similar procedures) water storage and TC also
a bracket during mastication was reported to be 40 to decreased the shear bond strength [20,39]. On the
120 N, the surface area of the bracket is approximately other hand, Lüthy et al. [40] found for some bonding
11.9 mm2 and therefore it should be able to resist procedures no significant differences between TC and
stress values between 6 and 8 MPa [16], during fixed water storage and water storage alone).
orthodontic treatment for clinical success [27]. The Since the load applied corresponded to the load that
mean bond strength values of brackets bonded is usually used in the clinic, one can expect that it has
to natural teeth are significantly lower than those little effect on the bond strength, which confirms the
obtained for surfaces other than enamel, especially clinical observations (few debondings of brackets).
when a chemical promoter such as silane is used during This explains that the control and load group showed
bonding [28]. These results may imply that universal the same shear bond strength. Since there are no
primer application alone, prior to bonding, would other publications that have subjected samples to
already enhance the bond strength of the orthodontic orthodontic load, it is not possible to compare the
resin composite tested. However, it is known that in vitro results of the present study with others.
bond strength values are often higher than in clinical It was surprising to see that the group with orthodontic
situations, and biodegradation of resin composites in load in combination with TC showed the best results,
the oral environment over time may even decrease which is difficult to explain. It seems that there is a
these values [29,32]. In addition, aging procedures synergetic effect of load and TC. It is known that, due
have a detrimental effect on the bond strength values to polymerization shrinkage, stress will be build up
of resin composites when compared to non-aging test at the interface. This stress can be slightly increased
conditions. [22,30,31]. in one direction by the orthodontic load. Under TC
As reported previously, long-term (two-year) water cyclic dimensional changes are induced, which may
storage [25] or 6000 thermocyles [20] decreased the damage the interface by creating additional stress
106 Stoma Edu J. 2018;5(2):102-108 http://www.stomaeduj.com
BONDING ORTHODONTIC RESIN CEMENT TO ZIRCONIUM OXIDE UNDER
ORTHODONTICS LOAD AND THERMOCYCLING EFFECT
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Hind S. HUSSEIN
BDS, Courtesy Clinical Assistant Professor
Department of Restorative Dental Sciences
College of Dentistry, University of Florida
FL 32608 Gainesville, USA
CV
Dr. Hind S Hussein graduated in 2011 (BDS) from the Almustansiryah University, Baghdad, Iraq. Between 2012 and 2014 she
worked in a public hospital and a private clinic in Baghdad. In 2013 she was certified in Orthodontics. In 2014 she completed
her Advanced Post Graduate Multispecialty Residency qualifying as a General Dentist. In 2014, Dr. Hussein joined the University
of Florida (UF) as Visiting scientist (Restorative Dental Science and Orthodontics). In 2017 she was certified as UF Graduate
Assistant Teacher with a technology program. Since 2017 up to the present, she has been an UF, a Courtesy Clinical Assistant
Professor, with the Operative Dentistry and Prosthodontics, of the Department of Restorative Dental Sciences. Since 2014 she
has been successfully involved in many research projects in dental materials. In 2017, Dr. Hussein submitted two US patents.
Dr. Hussein is a member of several professional organizations including the Iraqi Dental Association, AADR and IADR.
Questions
1. Hydrofluoric acid is used to increase the surface roughnes for bonding for the
following ceramics?
qa. Zirconium Oxide;
qb. Lithium disilicate ceramic only;
qc. All glass based ceramics;
qd. Leucite reinforced ceramic only.
2. The treatment with Co-jet sand provides the following?
qa. Roughens the surface;
qb. Roughens the surface and deposits a layer of silica;
qc. Cleans the surface;
qd. Polishes the surface.
3. Which surfaces can be primed with silane?
qa. Base metals;
qb. Gold alloys;
qc. Oxide ceramics e.g. Zirconium oxide;
qd. Surfaces containing silica, e.g. glass based ceramics.
4. Which is the ideal clinical protocol to bond to an all ceramic crown made out of
an unknown ceramic?
qa. Roughen surface with Co-jet, prime with Silane and use resin based orthodontic cement;
qb. Etch with hydrofluoric acid, prime with silane and use resin based orthodontic cement;
qc. Etch with phosphoric acid, use universal primer and use resin based orthodontic cement;
qd. Roughen surface with Aluminumoxide sand, use silane and cement bracket with glass ionomer cement.
108 Stoma Edu J. 2018;5(2): 102-108 http://www.stomaeduj.com