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RESEARCH AND EDUCATION Volumetric shrinkage and fi lm thickness of cementation materials for veneers: An
RESEARCH AND EDUCATION Volumetric shrinkage and fi lm thickness of cementation materials for veneers: An

RESEARCH AND EDUCATION

Volumetric shrinkage and lm thickness of cementation materials for veneers: An in vitro 3D microcomputed tomography analysis

Camila S. Sampaio, DDS, MS, a João Malta Barbosa, DDS, MSc, b Eduardo Cáceres, DDS, MS, c Lindiane C. Rigo, DDS, MS, d Paulo G. Coelho, DDS, MS, PhD, e Estevam A. Bonfante, DDS, MS, PhD, f and Ronaldo Hirata, DDS, MS, PhD g

ABSTRACT

Statement of problem. Few studies have investigated the volumetric polymerization shrinkage and lm thickness of the different cementation techniques used to cement veneers.

Purpose. The purpose of this in vitro study was to evaluate the volumetric polymerization shrinkage (VS) and lm thickness (FT) of various cementation techniques through 3-dimensional (3D) microcomputed tomography ( mCT).

Material and methods. Forty-eight arti cial plastic maxillary central incisors with standard preparations for veneers were provided by

a mannequin manufacturer (P-Oclusal) and used as testing models with the manufacturer s plastic veneers. They were divided into 8 groups (n=6): RelyX Veneer + Scotchbond Universal (RV+SBU); Variolink Esthetic LC+Adhese Universal (VE+ADU); Filtek Supreme Ultra Flowable + Scotchbond Universal (FF+SBU); IPS Empress Direct Flow + Adhese Universal (IEF+ADU); Filtek Supreme Ultra Universal

+ Scotchbond Universal (FS+SBU); IPS Empress Direct + Adhese Universal (IED+ADU); Preheated Filtek Supreme Ultra Universal + Scotchbond Universal (PHF+SBU); and Preheated IPS Empress Direct + Adhese Universal (PHI+ADU). Specimens were scanned before and after poly- merization using a mCT apparatus (mCT 40; Scanco Medical AG), and the resulting les were imported and analyzed with 3D rendering

software to calculate the VS and FT. Collected data from both the VS and FT were submitted to 1-way ANOVA ( a=.05).

Results. VE+ADU had the lowest volumetric shrinkage (1.03%), which was not signi cantly different from RV+SBU, FF+SBU or IEF+ADU ( P>.05). The highest volumetric shrinkage was observed for FS+SBU (2.44%), which was not signi cantly different from RV+SBU, IED+ADU, PHF+SBU, or PHI+ADU ( P >.05). Group RV+SBU did not differ statistically from the remaining groups ( P>.05). Film thickness evaluation revealed the lowest values for RV+SBU, VE+ADU, FF+SBU, and IEF+ADU, with an average between groups of 0.17 mm; these groups were signicantly different from FS+SBU, IED+ADU, PHF+SBU, and PHI+ADU ( P>.05), with an average of 0.31 mm.

Conclusions. Both the VS and the FT of direct restorative composite resins were higher than those of veneer cements and owable composite resins, whether preheated or not preheated. (J Prosthet Dent 2016; -: ---)

Materials provided by Ivoclar Vivadent and 3M Oral Care. Supported by FAPESP Young Investigators Award (grant 2012/19078-7); National Council for Science and Technological Development (CNPq; grants 309475/2014-7 and 307217-2014-0); and Coordination for the Improvement of Higher Education Personnel CAPES (grant 1777-2014). a Doctoral student, Department of Restorative Dentistry, State University of Campinas, Piracicaba, Brazil; Visiting Scholar, Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY; and Research Professor, Department of Biomaterials, Universidad de los Andes, Santiago, Chile. b PG International Program student, Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY; and Resident, Department of Advanced Education Program in Prosthodontics, New York University College of Dentistry, New York, NY. c Masters student, Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY. d Visiting Researcher, Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY. e Associate Professor, Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY. f Professor, Department of Prosthodontics, University of São PauloeBauru College of Dentistry, Bauru, Brazil. g Assistant Professor, Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY.

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2 Volume - Issue - Clinical Implications Different techniques for cementing esthetic veneers can produce different

Volume - Issue -

Clinical Implications

Different techniques for cementing esthetic veneers can produce different volumetric polymerization shrinkage and lm thickness of the interface tooth/ veneer, which can affect the long-term performance of the clinical treatment. Veneer cements and owable composite resins showed better results of polymerization shrinkage and lm thickness than preheated or not preheated direct restorative composite resins.

Advances in dental technology and biomaterials have led to the introduction of esthetic treatment options with minimal tooth preparation, such as ceramic and composite resin veneers. High predictability for color stability, mechanical strength, compatibility with the periodontal tissues, clinical longevity, and enamel-like appearance because of their translucency and super - cial texture have been reported. 1,2 When a thin veneer is bonded to a tooth surface with a composite resin cement, tooth morphology may be altered and the fracture strength of the selected restorative material increased. 3,4 Also, bonding to dentin results in lower fracture loads compared with bonding to enamel, and a thinner composite resin cement might result in higher fracture loads. 5 In addition, the intaglio surface t of indirect restorations and the cementation methods have been claimed to affect long-term clinical success by reducing the formation of porosities in the cement. 6 Veneers are usually cemented with light-polymerized composite resin cements because their longer working time facilitates excess cement removal and they improve the color stability and availability of try-in pastes. 1,7,8,9 Despite the availability of many composite resin cements for veneer cementation, other materials have been proposed. Flowable composite resins and preheated direct composite resin restorative materials have shown color stability comparable with that of light-polymerized cements. 7,10 Preheating com- posite resins has been advocated, 10-14 and when tested for direct restorative procedures has demonstrated better marginal adaptation compared with room tem- perature placement, probably because of closer adaptation to the cavity walls. 11 Whether bene ts in terms of t and volumetric shrinkage reduction are obtained when preheated composite resins are used to cement indirect restorations such as veneers remains unclear. A study evaluated the effect of composite resin cement polymerization shrinkage on stresses in ceramic crowns and concluded that stress increases in thicker

crowns and concluded that stress increases in thicker Figure 1. Standardized plastic maxillary central incisor

Figure 1. Standardized plastic maxillary central incisor and plastic veneer used as testing models.

cement layers. 15 In addition, a thicker lm exposes more cementation material to the oral environment, increasing its susceptibility to degradation. 16 Additionally, the owability of the materials can be affected by the per- centage of inorganic llers and the monomer system used in the composite resins. 17-19 The use of nondestructive microcomputed tomog- raphy ( mCT) has allowed the visualization of the poly- merization shrinkage vectors of composite resins, 20,21 volumetric shrinkage characterization, 22 leakage evalu- ation, 23 quanti cation of porosities incorporated into the cementation materials, 6 among other properties. mCT consists of a high-resolution digital imaging technique able to provide 2- and 3-dimensional (3D) data, allowing material analysis inside a given cavity con guration. 24 The purpose of this study was to investigate the volumetric polymerization shrinkage (VS) and lm thickness (FT) of various adhesive cementation techniques used for veneers through 3D mCT. The null hypotheses tested were that different cemen- tation techniques would not affect the volumetric polymerization shrinkage or lm thickness of veneer cementation.

MATERIAL AND METHODS

Forty-eight plastic maxillary central incisors with standard preparations for veneers were provided by a mannequin manufacturer (Ref 02D2114U; P-Oclusal) and along with their respective and standardized plastic veneers (1 mm thick) were used as testing models ( Fig. 1 ) to evaluate different veneer cemen- tation techniques and materials. Materials, batch numbers, composition, and ller loading are presen- ted in Table 1 . The specimens were divided into 8 groups (n=6 each) according to the material and

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- 2016 3 Table 1. Materials, batch numbers, composition, and fi ller loading of materials

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Table 1. Materials, batch numbers, composition, and ller loading of materials studied

Filler Loading,

Material (Manufacturer)

Batch

Composition

% vol

RelyX Veneer Cement Translucent Shade (3M ESPE [RV])

N666895

Bisphenol-A-diglycidylether dimethacrylate (BisGMA) and triethylene glycol dimethacrylate (TEGDMA) polymer. zirconia/silica and fumed silica llers, pigments, photoinitiators

47

Variolink Esthetic Light Polymerized Cement Neutral shade (Ivoclar Vivadent AG [VE])

T31913

Urethane dimethacrylate (UDMA) and further methacrylate monomers, ytterbium tri uoride, and spheroid mixed oxide, initiators, stabilizers, and pigments

38

Filtek Supreme Ultra Flowable dB1 Shade (3M ESPE [FF])

N678605

BisGMA, TEGDMA, and Procrylat resins, ytterbium tri uoride ller, nonagglomerated/nonaggregated silica ller, aggregated zirconia/ silica cluster ller

46

IPS Empress Direct Flow dTrans 30 (Ivoclar Vivadent AG [IEF])

S45776

Dimethacrylates, barium glass llers, ytterbium triuoride, highly dispersed silicon oxide, mixed oxide and copolymer, catalysts, stabilizers, and pigments

36

Filtek Supreme Ultra Universal dTrans CT shade; (3M ESPE [nonheated group, FS+SBU; preheated group, PHF+SBU])

N614852

BisGMA, UDMA, TEGDMA, and bisEMA resins, nonagglomerated/ nonaggregated silica ller, nonagglomerated/nonaggregated zirconia ller, and aggregated zirconia/silica cluster ller

56

IPS Empress Direct Material eTrans 30 (Ivoclar Vivadent AG [nonheated group, IED+ADU; preheated group, PHI+ADU])

R74424

Dimethacrylates, barium glass, ytterbium tri uoride, mixed oxide, silicon dioxide and copolymer, additives, catalysts, stabilizers and pigments

52-59

Scotchbond Universal (3M ESPE [SBU])

N653344

MDP phosphate monomer, dimethacrylate resins, HEMA, Vitrebond copolymer, ller, ethanol, water, initiators, silane

-

Adhese Universal (Ivoclar Vivadent AG [ADU])

T15773

Methacrylates, water, ethanol, highly dispersed silicon dioxide Initiators and stabilizers

-

adhesive system used for cementation: RelyX Veneer

+ Scotchbond Universal (RV+SBU); Variolink Esthetic

LC + Adhese Universal (VE+ADU); Filtek Supreme Ultra Flowable + SBU (FF+SBU); IPS Empress

Direct Flow + ADU (IEF+ADU); Filtek Supreme Ultra Universal (unit dose capsules) + SBU (FS+SBU); IPS Empress Direct (unit dose capsules)

+ ADU (IED+ADU) Preheated Filtek Supreme Ultra

Universal (unit dose capsules) + SBU (PHF+SBU); Pre-

heated IPS Empress Direct (unit dose capsules)

+ ADU (PHI+ADU). The 2-room temperature direct

restorative composite resin groups (FS+SBU and IED+ADU) were included as controls for the preheated groups. A schematic showing the steps for specimen prepa- ration is presented in Figure 2 . All the surfaces involved in the bonding procedure were pretreated with phos- phoric acid for 30 seconds (Ultra-Etch 35%; Ultradent Products Inc), followed by copious rinsing under water and oil-free air drying. For each group, the teeth were treated with a layer of its proprietary adhesive system, which was not light polymerized, according to manu- facturers instructions. Because the use of conventional direct restorative composite resins is not indicated for the

cementation of veneers, the adhesive system was used according to the instructions from the cements to stan- dardize the procedure. The cementation agent was applied to the entire surface of the veneer, which was immediately positioned over the tooth preparation. A calibrated operator (C.S.) cemented all the specimens. After seating of the restorations, the excess cement was removed with a disposable applicator (Microbrush; Microbrush Intl). For the preheated groups, adhesion procedures followed the

Sampaio et al

same steps previously described. In these groups, the unit dose composite resin capsules were protected with a plastic bag and heated in a water bath for 2.5 minutes, with temperature maintained at 68 ±2 C as controlled by a thermometer. 12 After their removal from the heating device, the seating procedure was timed for consistency across all specimens. The seating of the restoration was preformed subsequently with a syringe (Centrix Inc) to prevent cooling of the heated composite resin, and cementation was performed as previously described. Conventional composite resins were used in unit dose capsules, so each capsule was heated just once, for the cementation of 1 specimen only, to standardize the procedure and avoid heating the composite resin more than once. Each specimen was scanned twice with a mCT appa- ratus (mCT 40; Scanco Medical AG). The mCT was cali- brated using a phantom standard at 70 Kvp/Beam Hardening 200 mgHA/cm, and the operating condition for the mCT device was as follows: energy of 70 Kvpe114 mA with a voxel size of 30 mm per slice and an integration time of 30 minutes per specimen. After veneer cementation and before light polymeri- zation (prepolymerization scan), the specimens were positioned inside a mCT holder previously covered with a black opaque tape and then placed inside the mCT chamber. All specimens from the same group were scanned simultaneously before light polymerization. The volume quantication of the nonpolymerized composite resin cement was evaluated. After the rst scan was completed, the specimens were carefully removed from the mCT holder and light polymerized using a multi- wavelength light polymerization unit (Bluephase 20i; Ivoclar Vivadent AG) at a standardized distance of 1 mm.

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4 Volume - Issue - Figure 2. Schematic depicting specimen preparation. (A) Acid etching and bonding

Volume - Issue -

4 Volume - Issue - Figure 2. Schematic depicting specimen preparation. (A) Acid etching and bonding

Figure 2. Schematic depicting specimen preparation. (A) Acid etching and bonding procedures of tooth; (B) acid etching of veneer; (C) cement application on veneer; (D) cement excess removal; (E) stabilized veneer on tooth preparation; (F) light polymerization; and (G) mCT scan was taken before polymerization and second after polymerization.

The total light polymerization time was 80 seconds (20 seconds from labial, distal, mesial, and palatal surfaces). For the preheated groups (PHF+SBU and PHI+ADU), after the rst mCT scan, the specimens were removed from the holder and repositioned in a glass container reheated in a water bath for 2.5 minutes at 68 ±2 C. This was followed by a coo- ling period of 1 minute to simulate the manipula- tion time before the light polymerization protocol previously described. The specimens did not come into contact with water during the heating procedures. After the polymerization of all specimens had been completed, a second scan (postpolymerization) was made. For the rst and second scans, all specimens from the same group were scanned at once with a customized holder that oriented the specimens in the same position (with the veneer facing the top of the holder). The VS measurement apparatus is shown in Figure 3 and the FT evaluation in Figure 4 . The mCT scanning les were imported into a workstation for 3D data analysis and visualization (Amira v5.5.2; VSG). The step-by-step procedure for the mCT data evaluation

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C T data evaluation THE JOURNAL OF PROSTHETIC DENTISTRY Figure 3. Volumetric polymerization shrinkage at different

Figure 3. Volumetric polymerization shrinkage at different stages. Orange image shows images before polymerization, while blue shows after polymerization images; both were superimposed for shrinkage evaluation. Note that after superimposition, prepolymerization gures in orange remained in back of postpolymerized ones showing higher vol- ume, demonstrating where volumetric shrinkage was present (frontal view; mesial and distal views; and incisal view).

followed a previous study. 22 In the software, scans were superimposed with the software tool called Superimpo- sition before and after polymerization; this allowed

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- 2016 5 Figure 4. Film thickness. Orange images show tooth with veneer cemented. Green

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- 2016 5 Figure 4. Film thickness. Orange images show tooth with veneer cemented. Green images

Figure 4. Film thickness. Orange images show tooth with veneer cemented. Green images show cementation material images after polymerization for thickness evaluation after threshold was performed. Images after polymerization used for lm thickness (FT) measurements: frontal view of tooth (A), cementation material threshold with midline section (B), proximal view for obtaining cut for thickness evaluation (C), midline cut for thickness me a- surement (D), and thickness measurement itself, shown in millimeters (E).

arrangement of all the scans and visualization of the polymerization shrinkage for each specimen. Thresholds were visually determined for each specimen by a single calibrated operator (E.C.), as the same threshold could not be used for all groups because of the different radi- opacities and attenuation levels from the cementation materials. The Materials Statistics command was used to compute the volume of the cementation material before and after polymerization, and the VS changes were calculated as percentages. The cementation FT was measured after polymeriza- tion. For each specimen, the preparation midline was used as a reference. In the analysis software (Amira v5.5.2; FEI Co), a cross-sectional layer image was obtained with the tool surface cut, and 5 equidistant points dened from the most incisal to the most cervical area of the preparation were used for the measurements, which were calculated with the tool Measurement d3D Length; values were given in millimeters. The average value of the 5 FT measure- ments was calculated and used for comparison among groups.

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Table 2. Mean ±SD of volumetric polymerization shrinkage (VS) and lm thickness (FT) (n=6) determined for each material

Group

VS (%)

FT

RelyX Veneer (RV+SBU)

1.74 ±0.57 ABCD

0.17 ±0.03 B

Variolink Esthetic LC (VE+ADU)

1.03 ±0.46 D

0.21 ±0.04 B

Filtek Supreme Flowable (FF+SBU)

1.46 ±0.48 BCD

0.15 ±0.03 B

IPS Empress Flowable (IEF+ADU)

1.74 ±1.29 CD

0.16 ±0.02 B

Filtek Supreme (FS+SBU)

2.44 ±0.26 A

0.32 ±0.03 A

IPS Empress Direct (IED+ADU)

2.13 ±0.25 AB

0.31 ±0.03 A

Preheated Filtek Supreme (PHF+SBU)

2.09 ±0.40 AB

0.30 ±0.06 A

Preheated IPS Empress Direct (PHI+ADU)

1.95 ±0.33 ABC

0.31 ±0.04 A

Different superscript letters represent means that differ from each other in same column

( P<.05).

The obtained data were analyzed by 1-way ANOVA and the Tukey HSD post hoc test ( a=.05).

RESULTS

Table 2 summarizes the mean and standard deviation of the VS and FT for all groups. A signi cant statistical difference was found among groups ( P <.05). VS means ranged from 1% to approximately 2.5%. Group VE+ADU

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6 Volume - Issue - Figure 5. 3D reconstructions from groups RV+SBU, VE+ADU, FF+SBU, and EF+ADU

Volume - Issue -

6 Volume - Issue - Figure 5. 3D reconstructions from groups RV+SBU, VE+ADU, FF+SBU, and EF+ADU

Figure 5. 3D reconstructions from groups RV+SBU, VE+ADU, FF+SBU, and EF+ADU in frontal, incisal, mesial, and thickness views.

showed the smallest percentage shrinkage (1.03%) and FS+SBU the largest (2.44%). In general, light- polymerized veneer cements and owable composite resins presented lower VS than direct restorative com- posite resins ( P <.05), heated or not, demonstrating their clinical advantage for the cementation of veneers. Direct restorative composite resins, regardless of the tempera- ture, revealed a higher percentage of shrinkage ( P <.05) (2.1%) than the remaining groups (1.5%). Light- polymerized veneer cements and owable composite resins were not statistically different ( P >.05). No differ- ence in VS was observed between direct restorative composite resins either preheated or at room tempera- ture ( P >.05). Group VE+ADU presented the smallest percentage of VS, not statistically different from RV+SBU, FF+SBU, or IEF+ADU ( P >.05). The highest percentage of VS was observed in FS+SBU, which was not signi cantly difference from RV+SBU, IED+ADU, PHF+SBU, or PHI+ADU ( P >.05). Group RV+SBU was not statistically different from the remaining groups (P >.05) ( Table 2 ). FT data showed the smallest values for groups RV+SBU, VE+ADU, FF+SBU, and IEF+ADU, which were signi cantly different from FS+SBU, IED+ADU,

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PHF+SBU, and PHI+ADU ( P<.05). The 2 cements developed for veneer cementation and the 2 owable composite resins were not statistically different ( P>.05) but were statistically different from direct restorative com- posite resins, both preheated and at room temperature ( P <.05), demonstrating a clinical advantage. The 2 direct restorative composite resins studied also did not show a statistical difference when compared ( P>.05) ( Table 2 ). Qualitative 3D reconstructions revealed an apparent absence of cementation material in parts of the mesial and distal surfaces for all groups ( Figs. 5 , 6 ). In addition, shrinkage was mostly observed in the cementation margins at the preparation nish line.

DISCUSSION

The present study evaluated the volumetric polymeriza- tion shrinkage and lm thickness in an arti cial tooth veneer preparation plastic model bonded to its desig- nated restoration. The tooth preparation design and veneer geometry were chosen to simulate the clinical situation. The results showed that different cementation techniques would present different VS and FT, rejecting the rst and second null hypothesis.

Sampaio et al

- 2016 7 Figure 6. 3D reconstructions from groups FS+SBU, IED+ADU, PHF+SBU, and PHI+ADU in

- 2016

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- 2016 7 Figure 6. 3D reconstructions from groups FS+SBU, IED+ADU, PHF+SBU, and PHI+ADU in frontal,

Figure 6. 3D reconstructions from groups FS+SBU, IED+ADU, PHF+SBU, and PHI+ADU in frontal, incisal, mesial, and thickness views.

Results obtained from the analysis of FT indicated that light-polymerized veneer cements and owable com- posite resins were statistically similar, presenting less thickness than either direct restorative composite resins, preheated or at room temperature. This nding re ects the percentage of inorganic llers contained in these materials, greatest with the direct restorative composite resins. The percentage inorganic ller content has been shown to in uence the viscosity and owability of unpolymerized materials, 17,18 leading to the observation of a greater thickness in the present study and a higher amount of cement volume in the direct restorative composite resins groups. VS presented the same pattern of results as those found for FT. Generally, veneer cements and owable composite resins showed less VS than direct restorative composite resins, regardless of preheating. The higher percentage of inorganic llers in the direct restorative composite resins might be expected to cause less VS. 19 However, this was not demonstrated in the present study. The increased volume of material observed in the direct restorative composite resins groups may explain this nding because an increased volume of material and/ or an increased thickness when polymerized in a single

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moment is expected to increase the VS. 15 Although some studies have shown that preheating direct restorative composite resins leads to an increase in the degree of conversion and polymerization stresses because of the increase in radical and monomer mobility, 10,13 volumetric shrinkage has not been previously investigated. Other studies focused on preheated composite resins showed a temperature decrease caused by the manipu- lation time after removal from the heating device, 12,14 and that, although temperature remains suf ciently high to allow improved wetting of the cavity walls and marginal adaptation, monomer conversion of different composite resins is not signi cantly affected by pre- heating them to 68 C. 11 These ndings agree with the results obtained in the present study, where no signi - cant advantages were observed in preheated groups in comparison with room temperature groups in FT and VS. Even though a second operator (JB) assisted during the cementation of the specimens, the manipulation time after removal from the heating source was never less than 1 minute, leading to an expected decrease of the composite resin temperature. The mCT method was able to detect volumetric changes of thin layers of composite resin materials

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8 Volume - Issue - between scans made before and after polymerization. This technique has been

Volume - Issue -

between scans made before and after polymerization. This technique has been found to be ef cient in detecting volume alterations between materials. 6,20-24 This study s results suggest that, considering the VS and FT parameters only, the materials of choice for veneer cementation are either veneer cements or ow- able composite resins. However, because of the in vitro nature of this investigation, the results should be interpreted with caution, especially because the signi cance of the differences detected in the present study has not been veri ed as clinically signi cant. An additional limitation of this study was that the veneers were cemented on plastic teeth. Future studies should focus on the VS and FT of veneer cementa- tion in enamel and dentin substrates to determine differences in the behavior of materials with different substrates. Although the present results revealed similarity bet- ween veneer cements and owable composite resins, clinicians should be aware of the limitations of owable composite resins for veneer cementation. For instance, although both present high color stability, 1,7 the absence of try-in pastes is an important limitation for owable composite resins 9 and the removal of excess material, since its detection can at times be challenging. Thus, from a clinical standpoint, the use of owable composite resins for veneer cementation should be considered as a second option to veneer cementation systems.

CONCLUSIONS

Within the limitations of this in vitro study, the following conclusions were drawn:

1. The volumetric polymerization shrinkage of either preheated or not preheated direct restorative com- posite resins was signi cantly higher than that of veneer cements or owable composite resins. 2. The lm thickness of veneer cements and owable composite resins was signi cantly lower than the

lm thickness of direct restorative composite resins,

preheated or not.

REFERENCES

5. Rojpaibool T, Leevailoj C. Fracture resistance of lithium disilicate ceramics bonded to enamel or dentin using different resin cement types and lm thicknesses. J Prosthodont 27 Oct 2015. http://dx.doi.org/10.1111/jopr.12372. [Epub Ahead of Print].

Corresponding author:

Dr Camila Sobral Sampaio Department of Restorative Dentistry State University of Campinas Piracicaba Dental School Piracicaba, SP BRAZIL Email: camisobral@hotmail.com

Copyright © 2016 by the Editorial Council for The Journal of Prosthetic Dentistry.

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