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 Joo Malta Barbosa, DDS, MSc,b Eduardo Cceres, 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, PhDg

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 articial plastic maxillary central incisors with standard preparations for veneers were provided by
a mannequin manufacturer (P-Oclusal) and used as testing models with the manufacturers 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 signicantly 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 signicantly 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 So PauloeBauru College of Dentistry, Bauru, Brazil.
g
Assistant Professor, Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY.

THE JOURNAL OF PROSTHETIC DENTISTRY 1

2 Volume
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 benets 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
THE JOURNAL OF PROSTHETIC DENTISTRY
- Issue -
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 quantication 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
conguration.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
Sampaio et al
- 2016
Table 1. Materials, batch numbers, composition, and ller loading of materials studied
Material (Manufacturer) Batch
RelyX Veneer Cement Translucent Shade (3M ESPE [RV]) N666895
Variolink Esthetic Light Polymerized Cement Neutral T31913
shade (Ivoclar Vivadent AG [VE])
Filtek Supreme Ultra FlowabledB1 Shade (3M ESPE [FF]) N678605
IPS Empress Direct FlowdTrans 30 (Ivoclar Vivadent AG S45776
[IEF])
Filtek Supreme Ultra UniversaldTrans CT shade; (3M N614852
ESPE [nonheated group, FS+SBU; preheated group,
PHF+SBU])
IPS Empress Direct MaterialeTrans 30 (Ivoclar Vivadent R74424
AG [nonheated group, IED+ADU; preheated group,
PHI+ADU])
Scotchbond Universal (3M ESPE [SBU]) N653344
Adhese Universal (Ivoclar Vivadent AG [ADU]) T15773
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
3
Filler Loading,
Composition % vol
Bisphenol-A-diglycidylether dimethacrylate (BisGMA) and triethylene 47
glycol dimethacrylate (TEGDMA) polymer. zirconia/silica and fumed
silica llers, pigments, photoinitiators
Urethane dimethacrylate (UDMA) and further methacrylate 38
monomers, ytterbium triuoride, and spheroid mixed oxide, initiators,
stabilizers, and pigments
BisGMA, TEGDMA, and Procrylat resins, ytterbium triuoride ller, 46
nonagglomerated/nonaggregated silica ller, aggregated zirconia/
silica cluster ller
Dimethacrylates, barium glass llers, ytterbium triuoride, highly 36
dispersed silicon oxide, mixed oxide and copolymer, catalysts,
stabilizers, and pigments
BisGMA, UDMA, TEGDMA, and bisEMA resins, nonagglomerated/ 56
nonaggregated silica ller, nonagglomerated/nonaggregated zirconia
ller, and aggregated zirconia/silica cluster ller
Dimethacrylates, barium glass, ytterbium triuoride, mixed oxide, 52-59
silicon dioxide and copolymer, additives, catalysts, stabilizers and
pigments
MDP phosphate monomer, dimethacrylate resins, HEMA, Vitrebond -
copolymer, ller, ethanol, water, initiators, silane
Methacrylates, water, ethanol, highly dispersed silicon dioxide -
Initiators and stabilizers
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 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 Figure 3. Volumetric polymerization shrinkage at different stages.
from the same group were scanned at once with a Orange image shows images before polymerization, while blue shows
customized holder that oriented the specimens in the after polymerization images; both were superimposed for shrinkage
same position (with the veneer facing the top of the evaluation. Note that after superimposition, prepolymerization gures in
orange remained in back of postpolymerized ones showing higher vol-
holder).
ume, demonstrating where volumetric shrinkage was present (frontal
The VS measurement apparatus is shown in Figure 3
view; mesial and distal views; and incisal view).
and the FT evaluation in Figure 4. The mCT scanning
les were imported into a workstation for 3D data followed a previous study.22 In the software, scans were
analysis and visualization (Amira v5.5.2; VSG). The superimposed with the software tool called Superimpo-
step-by-step procedure for the mCT data evaluation sition before and after polymerization; this allowed

THE JOURNAL OF PROSTHETIC DENTISTRY Sampaio et al

- 2016 5

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 mea-
surement (D), and thickness measurement itself, shown in millimeters (E).

arrangement of all the scans and visualization of the Table 2. Mean SD of volumetric polymerization shrinkage (VS) and lm
polymerization shrinkage for each specimen. Thresholds thickness (FT) (n=6) determined for each material
were visually determined for each specimen by a single Group VS (%) FT

calibrated operator (E.C.), as the same threshold could RelyX Veneer (RV+SBU) 1.74 0.57ABCD 0.17 0.03B
Variolink Esthetic LC (VE+ADU) 1.03 0.46D 0.21 0.04B
not be used for all groups because of the different radi-
Filtek Supreme Flowable (FF+SBU) 1.46 0.48BCD 0.15 0.03B
opacities and attenuation levels from the cementation CD
IPS Empress Flowable (IEF+ADU) 1.74 1.29 0.16 0.02B
materials. The Materials Statistics command was used to A
Filtek Supreme (FS+SBU) 2.44 0.26 0.32 0.03A
compute the volume of the cementation material before IPS Empress Direct (IED+ADU) 2.13 0.25 AB
0.31 0.03A
and after polymerization, and the VS changes were Preheated Filtek Supreme (PHF+SBU) 2.09 0.40AB 0.30 0.06A
calculated as percentages. Preheated IPS Empress Direct (PHI+ADU) 1.95 0.33ABC 0.31 0.04A
The cementation FT was measured after polymeriza-
Different superscript letters represent means that differ from each other in same column
tion. For each specimen, the preparation midline was (P<.05).
used as a reference. In the analysis software (Amira
v5.5.2; FEI Co), a cross-sectional layer image
The obtained data were analyzed by 1-way ANOVA
was obtained with the tool surface cut, and 5
and the Tukey HSD post hoc test (a=.05).
equidistant points dened from the most incisal to the
most cervical area of the preparation were used for
RESULTS
the measurements, which were calculated with the
tool Measurementd3D Length; values were given in Table 2 summarizes the mean and standard deviation of
millimeters. The average value of the 5 FT measure- the VS and FT for all groups. A signicant statistical
ments was calculated and used for comparison among difference was found among groups (P<.05). VS means
groups. ranged from 1% to approximately 2.5%. Group VE+ADU

Sampaio et al THE JOURNAL OF PROSTHETIC DENTISTRY

6 Volume
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 signicantly 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 signicantly different from FS+SBU, IED+ADU,
THE JOURNAL OF PROSTHETIC DENTISTRY
- Issue -
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 articial 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
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 reects
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 inuence 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
Sampaio et al
7
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 sufciently
high to allow improved wetting of the cavity walls and
marginal adaptation, monomer conversion of different
composite resins is not signicantly 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
THE JOURNAL OF PROSTHETIC DENTISTRY
8 Volume
between scans made before and after polymerization.
This technique has been found to be efcient in detecting
volume alterations between materials.6,20-24
This studys 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
signicance of the differences detected in the present
study has not been veried as clinically signicant.
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 resins9 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 signicantly higher than that of
veneer cements or owable composite resins.
2. The lm thickness of veneer cements and owable
composite resins was signicantly lower than the
lm thickness of direct restorative composite resins,
preheated or not.
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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.
Sampaio et al