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Hindawi Publishing CorporationInternational Journal o DentistryVolume , Article ID ,pageshttp://dx.doi.org/.//

Research ArticleComposite Bonding to Stainless Steel Crowns Using a NewUniversal Bonding and Single-Bottle Systems

Mohammad Ali Hattan,1 Sharat Chandra Pani,1 and Mohammad AlOmari2

Division of Pediatric and Preventive Dentistry, Riyadh Colleges of Dentistry and Pharmacy, P.O. Box ,Riyadh , Saudi Arabia

Division of Restorative Dentistry, Riyadh Colleges of Dentistry and Pharmacy, P.O. Box , Riyadh , Saudi Arabia

Correspondence should be addressed to Sharat Chandra Pani; [email protected]

Received January ; Accepted March

Academic Editor: Francesco Carinci

Copyright Mohammad Ali Hattan et al. Tis is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properlycited.

Aim. Te aim o this study is to evaluate the shear bond strength o nanocomposite to stainless steel crowns using a new universalbonding system.Material and Methods. Eighty () stainless steel crowns (SSCs) were divided into our groups ( each). Packablenanocomposite was bonded to the lingual surace o the crowns in the ollowing methods: Group A without adhesive (controlgroup), Group B using a new universal adhesive system (Scotchbond Universal Adhesive, M ESPE, Seeeld, Germany), and GroupC and Group D using two different brands o single-bottle adhesive systems. Shear bond strengths were calculated and the types o

ailure also were recorded.Results. Te shear strength o Group B was signicantly greater than that o other groups. No signicantdifferences were ound between the shear bond strengths o Groups C and D. Te control group had signicantly lower shear bondstrength ( < 0.05) to composite than the groups that utilized bonding agents.Conclusion. Composites bonding to stainless steelcrowns using the new universal bonding agent (Scotchbond Universal Adhesive, M ESPE, Seeeld, Germany) show signicantlygreater shear bond strengths and ewer adhesive ailures when compared to traditional single-bottle systems.

1. Introduction

Stainless steel crowns (SSCs) are most commonly used orull coverage restoration o posterior primary teeth [].Given the nature o primary enamel, the need or a ull

coverage restoration in children is all the more important [].For children who presented with large, multisurace cariouslesions o the primary teeth, the American Academy oPediatric Dentistry recommended the ull coverage o crownsusing SSCs []. Despite their high success rate, this provenrestoration ofen ails to meetthe esthetic demands o patientsand their parents [,].

Esthetic SSCs are composite or porcelain coatings thatare chemically or mechanically attached to a metal copingwhich allows or a tradeoff between their respective strengthsand weaknesses []. Esthetic SSCs have several shortcomingsrelative to traditional SSC restorations such as requiring agreater reduction o tooth structure during preparation [],

inability to crimp the crown [], and repair o racturedcoatings sometimes requiring complete replacement []. Teshape o an esthetic SSC cannot be altered, because thiswould change the rigid metal coping structure beneath thesomewhat brittle composite, leading to the possibility o

uture racture o the composite []. Although there isdocumentation o the repair o ractured esthetic crowns[], replacement o the crown is ofen the only method omanaging such ailures [].

A treatment modality that allows or contouring o thecrownas well as adequate retention is thechair-side veneeringo composite to stainless steel crowns []. Te use o suchcrowns has been restricted by the poor esthetics o the metaldisplay due to inadequate bonding o the metal to composite[].

Recently, a dental adhesive has been developed or multi-purpose bonding (Scotchbond Universal, M-ESPE, See-eld, Germany). Tis adhesive, developed or repairs in

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International Journal o Dentistry

prosthodontic crowns, utilizes sel-etch phosphorylatedmethacrylates that are believed to result in more efficaciousbonding to metal as well as tooth structure [,]. However,to the researchers knowledge this system has not beentested on stainless steel crowns. Given the better bonding onanocomposites to stainless steel crowns than conventional

composites [], this study aimed to evaluate the bonding onanocomposites to stainless steel crowns using a universalbonding system.

2. Materials and Methods

.. Selection of Materials. Tis study tested the bond strengtho commercially available nanocomposite resins to pre-trimmed, precontoured posterior stainless steel crowns, (M,St. Paul, MN, USA) using a new universal bonding systemScotchbon (Universal Adhesive, M ESPE, Seeeld, Ger-many). Te bond strength obtained was compared to that ousing two currently available dentin bonding agents Adaper

Single Bond Plus (M ESPE, Seeeld Germany) and Prime &Bond N (Dentsply, Lichtenstein).o avoid any chance o incompatibility o the bonding

agent with the composite, each bonding agent was tested witha resin manuactured by the same manuacturer (ZX, MESPE; Ceram-X mono, Dentsply).

.. Power of the Sample. Te power o the sample wascalculated using the G-Power .. power analysis sofware(Universtat Kiel, Germany). Te minimum required sampleorthe one-way ANOVA andpost-hoc test, with alpha o .,was samples in each group.Tus a total o stainless steelcrowns were divided into our groups or the purpose o this

study.

.. Preparation of the Stainless Steel Crowns. Te lingualsuraces o pretrimmed, precontoured lower right pri-mary secondary molar crowns (size E) (M, St Paul) weresandblasted or seconds using a sandblasting machine toincrease retention (Protempomatic Z, Bego, Bremen, Ger-many). Ten the crowns were etched with % phosphoricacid (FineEtch , Spident Co. Ltd., Korea) or secondsand divided into our groups o SSCs each. In Group ASSCs were attached to a nanocomposite (ZX, M-ESPE)without the use o a bonding agent (control group). In GroupB SSCs were bonded to a nanocomposite (ZX, M-ESPE)

using the universal bonding system (Scotchbond UniversalAdhesive, M ESPE). InGroups C andD SSCs were bondedtonanocomposites using bonding agents rom their respectivemanuacturers (Adaper Single Bond Plus to ZX, M ESPE,and Prime & Bond N to Ceram-X Dentsply). Afer thatall SSCs were subjected to thermocycling ( cycles othermocycling between C and C) to simulate thermalchanges in the oral cavity using the technique.

.. Measurement of Bond Strength. In order to acilitatehandling o the samples the crowns were embedded in auniorm acrylic mold that exposed the lingual surace o eachcrown to be ready or testing (Figure). Ten the shear bond

F: Stainless steel crown bonded to composite, mounted in anacrylic resin template.

strength o the composite to the stainless steel crown wasmeasured using a universal testing machine (Instron Corp,Canton, MA, USA). A orce o N at an acceleration o. mm/minwas applied upon the crown-composite interacein a direction parallel to the long axis o the crown. All

strength readings were calculated in megapascals (MPa) andthe orce at which the bond ractured was recorded as theshear bond strength o the adhesive.

.. ypes of Failure. Afer the racture o the bond betweenthe composite and the stainless steel crown, the crownsamples were examined under a magniying loupe and a darkbackground to determine type o ailure (Figure ). Treedistinct types o ailure were recorded: (a) adhesive ailurewas recorded when the bond ailure was observed at theresin-stainless steel crown interace, (b) cohesive ailure wasrecorded when the bond ailure was observed within the resinand (c) mixed ailure when the bond ailure was located at the

resin stainless steel crown as well as within the resin [].

.. Statistical Analyses. All data was recorded and processedusing the SPSS ver. (IBM Inc., Armonk, NY, USA) dataprocessing sofware. Te one-way ANOVA was used tocompare the signicanceo differencein shear bond strengthsbetween the different groups. Intergroup variations wereurther illustrated using Scheffes post-hoc test. Pearsons ChiSquare was used to determine the signicance o differenceamong the types o ailure.

3. Results

ableshows the mean, standard deviations and coefficientso variance o the shear bond strengths o the differentgroups tested and subjected to the one-way ANOVA. Tecontrol group (without any bonding agent) had signicantlylower shear bond strength to composite than the groupsthat utilized bonding agents. Te one-way ANOVA showedthat this difference was signicant at < 0.0001. Post-hoc Scheffes test (able ) suggested that the shear bondstrength o Group B (Scotchbond Universal Adhesive) wassignicantly higher than that o both Group C (Prime & BondN) and Group D (Adaper Single bond Plus). No signicantdifferences were ound between the shear bond strengths oGroup C and Group D ( = .897).

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: Descriptive data o the shear bond strengths o the different groups.

Group Mean Std. Deviation Std. Error Sig

Spectrum + Prime & Bond N (D) . . .

. .ZX + Adaper (C) . . .

ZX + Universal (B) . . .

Control (A) . . .Calculated using one-way ANOVA.Differences signicant at < 0.001.

: ukeys HSD post-hoc test to highlight signicant differences between the different groups.

Group Subset or alpha = .

Control (A) .

Spectrum + Prime & Bond N (D) .

ZX + Adaper (C) .

ZX + Universal (B) .

Sig. . . .

Means or groups in homogeneous subsets are displayed.a. Uses harmonic mean sample size = ..

When the ailure type o bonding was compared, thecontrol group showed only adhesive ailure, while groups Cand D showed both adhesive and mixed ailures. Althoughthe universal bonding agent group (Group B) showed twosamples with pure cohesive ailure, this group had an equalnumber o adhesive and mixed ailures (able). Te typeo ailure observed in this group was however signicantlydifferent rom those observed in other groups.

4. Discussion

Full coverage restorations are ofen the only viable meanso restoring badly decayed primary teeth []. Pediatricdentists have recognized the need or an esthetic alternativeto stainless steel crowns or anterior teeth [], and similarlyposterior teeth too; parental demand or esthetics has orcedpediatric dentists to look at more esthetic options such aspreveneered or open-aced crowns [].

Although parent satisaction has been reported with pre-veneered stainless steel crowns [], drawbacks such as diffi-culties in shade matching [], tendencies or the veneered

suraces to racture [], limited ability to crimp the crown[], and ears over long-term clinical perormance [] haveprevented their universal acceptance by dentists. A higherrate o clinical success has been reported with open-acedstainless steel crowns although their esthetic acceptability hasbeen questioned [].

While initialstudieson thebonding o composite to stain-less steel crowns predicted acceptable shear bond strengths[,,], it has been ound that mechanical modicationsimprove the bond strength [,]. Sandblasting was chosenas the method to improve retention o the composite tothe crown as the equipment is available in most labs andsince it is less time consuming and easier to standardize

when compared to methods such as welding o orthodonticbrackets or creation o grooves manually with a bur [].

Te shear bond strength obtained with the single bottleadhesives were in the range obtained by previous studiesusing similar adhesives [,]. Te lack o any signicantdifferencebetween manuacturersseems to validatethe initialhypothesis and conrm the need to test newer bondingsystems. Te results showed that the universal bondingsystem showed a signicantly higher shear bond strength and

lower incidence o adhesive ailure than both single bottleadhesives indicating that there could be potential or clinicalapplications o this system in bonding composite to stainlesssteel.

Te bonding ailure type has been used as a measure othe success o the bond o adhesive restorations to stainlesssteel crowns [,]. Adhesive ailures have been consideredunacceptable, mixed ailures acceptable, and cohesive ailuresideal []. While studies have reported adhesive and mixedailures in the bonding o composite to stainless steel crownsthere have been ew reports o cohesive ailure []. In thiscontext, the signicantly ewer adhesive ailures and ndingo cohesive ailure in the group that bondedwith the universal

bonding agent are o signicance. However it must be notedthat even the group that bonded with universal bonding agentshowed incidence o adhesive ailure, suggesting that clinicaltrials o this material are needed to validate the ndings othis study.

Because o the relative novelty o the universal bondingagent, there is little available literature on the mechanismo action o this agent. A recent study suggested using sel-etching adhesives that utilize -methacryloyloxydecyl dihy-drogen phosphate (MDP) orm sel-assembled nanolayersat the tooth-bond interace, which could be the reason ortheir higher bond strengths to tooth []. However both thepresence o this layer and the easibility o this explanation

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: ypes o ailure observed.

Group ype o ailure

Chi Square SigAdhesive Cohesive Mixed

Spectrum + Prime & Bond N

ZX + Adaper . .

ZX + Universal

Control

Differences signicant at < 0.01.

(a) (b) (c)

F : ypes o ailure o shear bond strength: (a) adhesive ailure, (b) mixed ailure, and (c) cohesive ailure.

with regards to metal bonding need urther evaluation. Tisstudy used only the universal bonding agent since none o theother commercially available MDP systems claim increasedbonding to metal.

Te racture o the veneering o pre-veneered stainless

steel crowns has been reported to result in loss o spaceand retention o plaque [,]. Te repair o the racturedveneer has been reported to be unsuccessul, mainly becauseo the lack o adequate bonding to the metal surace [].Teresults o this study suggest that the higher bond strengthso universal bonding agent could indicate the need to studytheir possible use in the repair o ractured veneers o estheticstainless steel crowns.

5. Conclusions

Composites that bonded to stainless steel crowns with the

new universal bonding agent show signicantly greater shearbond strengths and ewer adhesive ailures when comparedto traditional single bottle systems. Further clinical researchis needed to evaluate the in vivo potential o this system.

Conflict of Interests

Te authors conrm that no nancial assistance was receivedrom the manuacturers o any o the products used in thestudy. Te authors have never been employed or served asconsultants or the manuacturers o any o the productsmentioned in this study.

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