A Polymer-Infiltrated Ceramic as Base Adherent in an Experimental Specimen Model to Test the Shear Bond Strength of CAD-CAM Monolithic Ceramics Used in Resin-Bonded Dental Bridges

Round 1

Reviewer 1 Report

Comments for author File: Comments.pdf

No need

Author Response

Dear Reviewer.

Thank you for your remarks and for helping us to improve the paper.

We emphasize that the quantity and, therefore, the number of the figures have changed in the revised manuscript. The English language was edited.

These are point by point our answers.

1. The error units of measurement of the whole manuscript should be correct, as “mW/cm2” should be “mW/cm2 ” in Line 231. Authors answer 1: The detail was rectified

2. The expression of Figures should be uniform. The author should choose one of them as “Figure X” or “Fig. X”, but not for both of them, as shown in Line 254 (Figure 10) and Line 263 (Fig.11). Authors answer 2: The detail was rectified.

3. The alumina should be expressed as “Al2O3” but not “AL2O3” in Figure 20. Authors answer 3: The detail was rectified

 

4. The microscopy observation in Figure 20 is not clear enough to display the fracture of the samples, where the SEM images should be added for further failure mechanism explanation Authors answer 4: It is not clear to the authors whether the reviewer refers to former figure 17 (examples of fracture modes) or former figure 20 (effect of surface treatments). In any of the situations, it was not thought essential to perform SEM, since the information obtained with the magnification crossed with the information with the naked eye, leaving no doubt about the fracture mode for each specimen and the tendency within each group. In any case, accepting the reviewer's criticism, the authors complemented the legend of the actual Figure 15 to facilitate the complementation with information from the actual Figure 14.

Reviewer 2 Report

The manuscript studies use of ENA as a base adherent in shear bond test. 

Minor edits

1. Title of the manuscript and absrtact doesn't accurately describe theme of the paper. Recommend capturing dental prostheses.

2. There are many figures in main manuscript. Recommend moving some figures to supporting section

3. The method and result sections are well written. However, the goal of this study and conclusion is not clearly written. How do the conlusions tie in with dental prostheses application that the authors are trying to solve.

Author Response

Thank you for helping us to improve the paper.

The English language was edited.

1. Title of the manuscript and abstract doesn't accurately describe theme of the paper. Recommend capturing dental prostheses.

Authors answer 1:

Accepting the suggestion, the title was modified to "A polymer infiltrated ceramic as a base adherent in an experimental sample model to test the shear strength of CAD-CAM monolithic ceramics used in resin-bonded bridges.”

The abstract was slightly modified: “Traditional load-to-failure tests fail to recreate clinical failures of all-ceramic restorations. Experimental fabrication, similar to prosthetic laboratory and clinical procedures, best predicts future clinical performance. A hybrid ceramic adherend mechanically similar to a human tooth was tested by comparing the shear bond strength (SBS) and fracture mode of four restorative materials adhered with a dual-cure adhesive cement. Surface energy, shear bond strength (SBS), and fracture mode were assessed. Vita Enamic (ENA), Vita Suprinity (SUP), Vita Y-TPZ (Y-ZT), and a nanohybrid composite (RES) (control group) cylinders, adhered with RelyX Ultimate to ENA blocks were assembled in experimental specimens simulating a 3-unit resin-bonded dental bridge. The ENA adherend was ground or treated with 5% hydrofluoric acid for 60 s. Monobond Plus was used as the coupling agent. Mean shear stress (MPa) was calculated for each group. Forest plots by material elaborated after calculating the difference in means and effect size (α=.05; 95% CI; Z-value=1.96) revealed significant differences in the shear force behavior between materials (p < 0.01). RES (69.10 ± 24.58 MPa) > ENA (18.38 ± 8.51 MPa) > SUP (11.44 ± 4.04 MPa) > Y-ZT (18.48 ± 12.12 MPa). Y-ZT and SUP exhibited pretest failures. SBS was not related to surface energy. The failure mode was material-dependent and exclusively adhesive in Y-ZT. ENA is a potential adherend for dental materials SBS tests. In this experimental design, it withstood 103 MPa of adhesive stress before cohesive failure.

 

2. There are many figures in main manuscript. Recommend moving some figures to supporting section Authors answer 2: The authors deleted 1 image and merged five, reducing the total number from 21 to 17. We believe that transferring some images to supplements causes breaks in the sequence of the paper reading, making it less appealing.

 

3. The method and result sections are well written. However, the goal of this study and conclusion is not clearly written.

Authors answer 3: The goals are now more explicit: “This study aimed to test a hybrid ceramic as an adherend for shear bond tests in an experimental specimen model. In parallel, the model was used to evaluate the mechanical behavior of four materials, of which three CAD-CAM monolithic ceramics, potential materials to rehabilitate clinical maxillary lateral incisor agenesis situations. The null hypotheses were that the hybrid ceramic was not a mechanically suitable adherend for shear bond tests and that no differences would be found in the mechanical behavior between the CAD-CAM monolithic ceramics.”

 

4. How do the conlusions tie in with dental prostheses application that the authors are trying to solve.

 Authors answer 3:  A new paragraph was added to the conclusions section: Tested CAD-CAM ceramics have sufficient adhesive strength to be used as resin-bonded bridges for permanent or interim rehabilitation, provided an efficient adhesive protocol is wisely chosen, and the need for short-term removal is equated as Y-ZT is very difficult to be removed by drilling.

Reviewer 3 Report

Manuscript ID: Coatings-2467375

In the current exploration, the authors investigate A polymer-infiltrated ceramic as a base adherent in an experimental specimen model to test the shear bond strength of CAD-CAM monolithic ceramics. An experimental study has been done. The work seems to be interesting, original, and also well-developed. Figures as well as Tables are also included for better improvisation. I recommend the publication of the manuscript after minor changes. My suggestions are listed below:

Ø  What is the main contribution addressed by authors regarding the field?

Ø  Abstract should be enhanced with major results.

Ø  References are appropriate but it will be better if authors add some recent papers regarding to your study.

Advantages and disadvantages CAD-CAM should be included if possible.

Minor editing of English language is required.

 

Author Response

Thank you for your comments.

Ø  1 - What is the main contribution addressed by authors regarding the field? Authors answer 1:  To reinforce this issue, upon suggestion, a section” 2. Research significance” was added: “ To the best of our knowledge, this experimental model is innovative because it uses an industrially produced material as an adherend from which a uniform composition is expected, unlike what happens with biological materials. Its hybrid constitution gives it a mechanical behavior hypothetically similar to the human tooth. It makes it a candidate material for use in future adhesive strength tests of dental materials, at least in preliminary studies, to identify significant differences easily and rapidly between restorative materials. This would overcome ethical constraints and results biases inherent in using biological materials.”

 

Ø  2 - Abstract should be enhanced with major results. Authors answer 2:  The abstract was slightly modified, and the results have a new writing: “Forest plots by material elaborated after calculating the difference in means and effect size (α=.05; 95% CI; Z-value=1.96), revealed significant differences in the shear force behavior between materials (p < 0.01). RES (69.10 ± 24.58 MPa) > ENA (18.38 ± 8.51 MPa) > SUP (11.44 ± 4.04 MPa) > Y-ZT (18.48 ± 12.12 MPa). Y-ZT and SUP exhibited pre-test failures. SBS was not related to the surface energy of the substrate. The failure mode was material-dependent. ENA is a potential adherend for dental materials SBS tests. It withstands 103 MPa of adhesive stress before cohesive failure in this experimental design.”

 

Ø  3 - References are appropriate but it will be better if authors add some recent papers regarding to your study.

Authors answer 3:  In the discussion section, a paragraph was added: “               No studies were found that would allow comparing the results of this study with other existing ones. This was due to the lack of adhesive protocols and adherends standardization, findings in agreement with a recent meta-analysis that identified 686 protocols to adhere 37 different CAD-CAM blocks [1], but also to the fact that frequently results are not available in MPa, not allowing credible comparisons.

 

The authors added some references:

Fung, L.; Brisebois, P. Implementing Digital Dentistry into Your Esthetic Dental Practice. Dent Clin North Am 2020, 64, 645-657, doi:10.1016/j.cden.2020.07.003.

Watanabe, H.; Fellows, C.; An, H. Digital Technologies for Restorative Dentistry. Dent Clin North Am 2022, 66, 567-590, doi:10.1016/j.cden.2022.05.006.

Tian, Y.; Chen, C.; Xu, X.; Wang, J.; Hou, X.; Li, K.; Lu, X.; Shi, H.; Lee, E.S.; Jiang, H.B. A Review of 3D Printing in Dentistry: Technologies, Affecting Factors, and Applications. Scanning 2021, 2021, 9950131, doi:10.1155/2021/9950131.

Gad, M.M.; Fouda, S.M. Factors affecting flexural strength of 3D-printed resins: A systematic review. J Prosthodont 2023, 32, 96-110, doi:10.1111/jopr.13640.

Mazza, L.C.; Lemos, C.A.A.; Pesqueira, A.A.; Pellizzer, E.P. Survival and complications of monolithic ceramic for tooth-supported fixed dental prostheses: A systematic review and meta-analysis. J Prosthet Dent 2021, 128, S0022-3913(0021)00065-00062, doi:10.1016/j.prosdent.2021.01.020.

Leitão, C.; Fernandes, G.V.O.; Azevedo, L.P.P.; Araújo, F.M.; Donato, H.; Correia, A.R.M. Clinical performance of monolithic CAD/CAM tooth-supported zirconia restorations: systematic review and meta-analysis. J Prosthodont Res 2022, 66, 374-384, doi:10.2186/jpr.JPR_D_21_00081.

Tosun, B.; Yanıkoğlu, N. Evaluation of the effects of different surface modification methods on the bond strength of high-performance polymers and resin matrix ceramics. Clin Oral Investig 2022, 26, 3781-3790, doi:10.1007/s00784-021-04348-y.

Fathy, H.; Hamama, H.H.; El-Wassefy, N.; Mahmoud, S.H. Effect of different surface treatments on resin-matrix CAD/CAM ceramics bonding to dentin: in vitro study. BMC Oral Health 2022, 22, 635, doi:10.1186/s12903-022-02674-5.

Hilgemberg, B.; Siqueira, F.S.F.; Cardenas, A.F.M.; Ribeiro, J.L.; Dávila-Sánchez, A.; Sauro, S.; Loguercio, A.D.; Arrais, C.A.G. Effect of Bonding Protocols on the Performance of Luting Agents Applied to CAD-CAM Composites. Materials (Basel) 2022, 15, doi:10.3390/ma15176004.

Narwani, S.; Yadav, N.S.; Hazari, P.; Saxena, V.; Alzahrani, A.H.; Alamoudi, A.; Zidane, B.; Albar, N.H.M.; Robaian, A.; Kishnani, S.; et al. Comparison of Tensile Bond Strength of Fixed-Fixed Versus Cantilever Single- and Double-Abutted Resin-Bonded Bridges Dental Prosthesis. Materials (Basel) 2022, 15, doi:10.3390/ma15165744.

Fouquet, V.; Lachard, F.; Abdel-Gawad, S.; Dursun, E.; Attal, J.P.; François, P. Shear Bond Strength of a Direct Resin Composite to CAD-CAM Composite Blocks: Relative Contribution of Micromechanical and Chemical Block Surface Treatment. Materials (Basel) 2022, 15, doi:10.3390/ma15145018.

Yano, H.T.; Ikeda, H.; Nagamatsu, Y.; Masaki, C.; Hosokawa, R.; Shimizu, H. Correlation between microstructure of CAD/CAM composites and the silanization effect on adhesive bonding. J Mech Behav Biomed Mater 2020, 101, 103441, doi:10.1016/j.jmbbm.2019.103441.

Reviewer 4 Report

coatings-2467375

Manuscript Title: "A polymer-infiltrated ceramic as a base adherent in an experimental specimen model to test the shear bond strength of CAD-CAM monolithic ceramics"

 

The authors did a good job of studying the A polymer-infiltrated ceramic as a base adherent in an experimental specimen model to test the shear bond strength of CAD-CAM monolithic ceramics; This scope needs such studies. However, in order to raise the quality of the manuscript to bring it to the required level in the journal “Coatings”, the reviewer recommends a deep processing of the comments (attached).

Comments for author File: Comments.pdf

Author Response

Thank you for the help. Attached is the file with the responses to your helpful comments. In the manuscript, relative to the original submission, everything highlighted in yellow has been introduced and language corrections are highlighted in red.

 

Author Response File: Author Response.docx

Round 2

Reviewer 4 Report

The manuscript has been well revised and can be processed for the next stage of publication.