Biaxial flexural strength and Weilbull characteristics of adhesively luted hybrid and reinforced CAD/CAM materials to dentin: effect of self-etching ceramic primer versus hydrofluoric acid etching

This study evaluated the influence of the surface treatment and aging on the biaxial flexural strength of ceramic materials cemented to a dentin analogue. One hundred twenty disc-shaped specimens were allocated into 12 groups considering three study factors: ceramic material (lithium disilicate, leucite-based ceramic and hybrid ceramic), surface treatment (10% hydrofluoric acid etching + silane or self-etching glass-ceramic primer) and Aging (with 10,000 thermocycles of 5-37-55 degrees C or without). A tri-layer assembly was designed to mimic a cemented restoration (Variolink N) into a dentin analogue. All samples were submitted to the biaxial flexural strength assay. The flexural strength in MPa was calculated using the finite element method for each sample considering thickness, material properties, and the load to fracture during the in vitro test. Fractographic analysis was also performed. The data was evaluated using three-way ANOVA and Tukey test (alpha = 5%). ANOVA showed influence for the Material*Treatment*Aging interaction on the flexural strength (p = 0.011). The highest strength was calculated for lithium disilicate ceramic + self-etching ceramic primer without aging (499 +/- 17 MPa)(A) and the lowest value for hybrid ceramic material + acid etching with aging (424 +/- 48 MPa)(E). According to the Weibull modulus, the most predictable strength was calculated for lithium disilicate + acid etching after aging. Acid etching or self-etching ceramic primer promotes similar immediate biaxial flexural strength for each evaluated ceramic. In the long-term, superior strength was observed using acid etching for lithium disilicate and the self-etching ceramic primer for the hybrid ceramic while no difference was observed for leucite-based ceramic.