Effect of Ceramic Thickness on the Polymerization Quality and Film Thickness of Dual-Polymerizing Versus Heated Light-Polymerizing Adhesive Cement

Statement of problem The clinical success of ceramic veneers cemented with preheated composite resin has been reported to be acceptable. Although the cementing technique requires sufficient light energy to activate its polymerization, the ability of light to penetrate through ceramic restorations of different thicknesses is unclear. Purpose The purpose of this in vitro study was to evaluate the polymerization quality and bond joint thickness of a dual-component adhesive and a heated composite resin when bonding ceramic onlays of varying thicknesses. Material and methods Sixty noncarious maxillary premolars, extracted for orthodontic or periodontal reasons, were divided into 6 groups (n=10) and sectioned apically to the marginal ridge. Computer-aided design and computer-aided manufacturing (CAD-CAM) was used to create onlays of varying thicknesses. Following the manufacturers ' instructions, the onlays were cemented using a dual-polymerizing resin for group DP1, DP2, and DP3 groups and preheated light-polymerizing resin for groups LP1, LP2, and LP3. The numbers indicate onlay thickness in each group. Vickers testing was performed 24 hours after polymerization, with a 0.49-N static load applied for 10 seconds. Film thickness was analyzed under an optical microscope, and temperature changes were measured using a thermal imaging camera. Statistical analysis was done with the 2-factor mixed ANOVA tests (α=.05). Results The Vickers hardness of a dual-polymerizing cement was lower compared with heated light-polymerizing cement (P<.05). Moreover, the thickness of the resin-ceramic restoration did not significantly affect the polymerization of a dual-polymerizing cement. However, the polymerization of the preheated light-polymerizing composite resin in group LP3 was significantly lower compared with other thicknesses (P<.05). In group LP3, the Vickers hardness of the tooth adjacent to the surface of the cement (DX2) was lower compared with indentations closer to the restoration surface (DX3, DX6), demonstrating a reduction in polymerization in the internal part. In addition, the mean film thickness of the dual-polymerizing groups (96 ±18 µm) was significantly lower than of the heated light-polymerizing groups (294 ±64 µm) (P<.05). A temperature reduction of 15 °C in the heated composite resin was also observed after 8 seconds Conclusions The thickness of the ceramic restoration did not significantly affect the polymerization of a dual-polymerizing cement. However, the polymerization of the preheated light-polymerizing composite resin under the same ceramic restoration with a thickness of 3 mm was significantly lower. In addition, the mean film thickness for the dual-polymerizing composite resin groups was significantly lower than for the heated light-polymerizing composite resin groups.