Long-term retention of zirconia crowns cemented with current automixed cements

Abstract

Statement of problem: Automixing and dispensing cements is a straightforward approach with consistent dosing. Previous studies have demonstrated clinically significant differences in crown retention between power-liquid and paste-paste forms of the same cement, as the composition between the 2 differs. A self-adhesive modified-resin (SAMR) and a resin-modified glass ionomer (RMGI) cement, originally offered as a powder-liquid, are now in common use as paste-paste automixed cements. With the increased use of zirconia restorations, the long-term retention of zirconia crowns for these 2 automixed cements should be evaluated.

Purpose: The purpose of this in vitro study was to determine whether zirconia crowns cemented with 2 automixed cements provided clinically acceptable retention after 6 months of aging with monthly thermocycling.

Material and methods: Extracted molars were mounted in resin and prepared with a flat occlusal surface, 20-degree taper, approximately 4-mm axial length, and with the axio-occlusal line angle slightly rounded. Prepared teeth were equally distributed into 3 cementation groups (n=12) to achieve nearly equal mean preparation surface areas for each group. Zirconia crowns (IPS ZirCAD LT) were fabricated with an added occlusal bar to facilitate removal of the cemented crowns. Cement space was set at 45 μm axially and 55 μm occlusally. After sintering and before delivery, the intaglio surfaces were airborne-particle abraded with 50-μm alumina at 275-kPa pressure for 3 seconds and then steam cleaned. Cements were the original powder-liquid RelyX Luting (RMGI; RXL) as the control, paste-paste, automixed systems RelyX Luting Plus Automix (RMGI; RXLA), and RelyX Unicem 2 Automix (SAMR; RXUA). Crowns were cemented under 196 N force, placed in an oven at 37 °C and 100% humidity during setting and then thermocycled (5 °C-55 °C) for 5000 cycles monthly for 6 months. The crowns were removed axially with a universal testing machine at 0.5 mm/min. Removal forces were recorded and dislodgement stress calculated by using the surface area of each preparation. One-way ANOVA was used for dislodgement stress and force. Chi-square test was used for cement location after testing (α=.05).

Results: RXLA demonstrated considerably lower crown retention (1.3 MPa) and differed significantly (P<.001) from RXUA (3.1 MPa) and RXL (3.1 MPa). Modes of failure showed most of the cement remaining only in the crown intaglio for RXLA for all specimens, whereas half of the crowns for RXL and RXUA demonstrated cement adhesion to both dentin and the intaglio surface, indicating cohesive failure of the cement at separation. As the Levene test was significant, the Games-Howell test was used for mean differences. The χ² analysis was significant.

Conclusions: After long-term aging with monthly thermocycling, high-strength zirconia crowns were strongly retained by 2 (RXL, RXUA) of the 3 cements. Crown retention for RelyX Luting Plus Automix was less than half in comparison and with cement found only on the intaglio surface after separation.