Shear bond strengths of polymethyl methacrylate to cast titanium and cobaltchromium frameworks using five metal primers

Chikahiro Ohkubo, DMD, PhD,a Ikuya Watanabe, DDS, PhD,b Toshio Hosoi, DDS, PhD,c and Toru Okabe, PhDd Baylor College of Dentistry, Texas A&M University System Health Science Center, Dallas, Texas Statement of problem. Poor chemical bonding of a denture base resin to cast titanium frameworks often
introduces adhesive failure and increases microleakage.

Purpose. This study examined the shear bond strengths of a denture base resin to cast pure titanium,
Ti-6Al-4V, and a cobalt-chromium alloy using various adhesive primers. Material and Methods. Disks (6.0 mm diameter, 2.5 mm thick) were cast of the 3 alloys. The disk surfaces were grit-blasted with 50 m alumina and treated with 5 different metal primers (Metal Primer II [MP]; Cesead Opaque primer [OP]; Meta Base [MB]; experimental primer [EP]; Siloc bonding system [SI]). A denture base resin (Palapress Vario) was then applied on the disks with hole-punched sticky tape (bonding area of 5.0 mm) and a Teflon (PTFE, New Age Industries Inc, Willow Grove, Pa.) ring (6.0 mm diameter 2.0 mm thick). Specimens without primer were also prepared as controls. All specimens were immersed in 37C water and thermocycled up to 2000 cycles. Shear bond strength values were determined at a crosshead speed of 0.5 mm/min. Data were statistically analyzed using 3-way ANOVA, followed by 1way ANOVA and the Scheff multiple range test. Results. Primers significantly (P<.05) improved shear bond strengths of denture base resin to all metals, among which no significant differences were found. Specimens primed with OP, MP, and EP showed higher bond strengths than did those primed with MB. After thermocycling, the bond strengths of MB and SI decreased substantially; MB showed the least durability (22.8% to 35.5% decrease) among the primers. Conclusion. The application of 5 primers significantly improved the shear bond strengths of a denture base resin to cast CP titanium, Ti-6Al-4V, and Co-Cr alloy. OP and MP primers exhibited greater bond strength and durability than did MB and SI. (J Prosthet Dent 2000;83:50-7.)

CLINICAL IMPLICATIONS
This study evaluated the shear bond strength and durability of PMMA denture base resin to cast CP titanium and Ti-6Al-4V alloy using 5 adhesive primers. The use of Opaque primer and Metal Primer II produced consistent and durable bonds to the cast titanium.

he mechanical retention for a denture resin (PMMA) in removable prostheses is usually provided by the framework design in the denture base, for example, by using beads, posts, bars, an open lattice, a mesh, or some macroscopic retentive design.1,2 Correct positioning of the finish lines and the sharply undercut line angles of the denture resin margin are also required to prevent failure of the resin at the junction with the
Partially supported by NIDCR grant DE 11787 from the National Institutes of Health, Bethesda, Md. aAssistant Professor, Department of Biomaterials Science, and Instructor, Department of Removable Prosthodontics, Tsurumi University School of Dental Medicine, Yokohama, Japan. bAssistant Professor, Department of Biomaterials Science, and Instructor, Department of Fixed Prosthodontics, Nagasaki University, School of Dentistry, Nagasaki, Japan. cProfessor and Chairman, Department of Removable Prosthodontics, Tsurumi University School of Dental Medicine, Yokohama, Japan. dProfessor and Chair, Department of Biomaterials Science. 50 THE JOURNAL OF PROSTHETIC DENTISTRY

framework.3,4 Chemical bonding between the metal framework and the denture base resin is also important. Poor chemical bonding in that area is a significant clinical problem, often introducing adhesive failure and increasing microleakage of oral fluids in the finish lines, which causes an accumulation of oral debris, microorganisms, and stains.4,5 As a result, the propagation of microorganisms contributes to an unfavorable soft tissue response. For approximately 20 years, the application of a 4-methacryloxyethyl trimellitate anhydride (4-META) bonding system to removable partial dentures (RPDs) has been studied and discussed as a way to prevent the problems previously mentioned.3,6 Yasuda et al6 reported that higher bond strength was obtained for cobalt-chromium (Co-Cr) alloy with a 4-META bonding system and also suggested in a longitudinal in vivo research study7 that the bond formation between these materials is clinically stable.
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Co-Cr alloys are commonly used for RPDs and complete dentures that incorporate metal components. Compared with alternative type IV gold alloys, Co-Cr alloys are relatively inexpensive, and they are approximately twice as rigid, but they may contain elements (Co and or Cr) alleged to bring about sensitivity or allergic reactions in some patients.8 Because of titaniums potential to reduce and eliminate some of these reported problems of Co-Cr alloys, titanium has been increasingly used in clinical practice for removable prostheses. To evaluate the usefulness of commercially pure (CP) titanium as a material for cast partial denture frameworks, a follow-up examination of patients who used titanium prostheses was conducted by Yamauchi et al.9 As a result of this follow-up study, it was found that there were no clinical problems with cast CP titanium partial denture frameworks. However, dye penetration from the finish line was found, despite the use of an adhesive resin containing 4-META (METADENT, Sun Medical, Kyoto, Japan) as the denture base resin. In a study of this phenomenon, Matsumura et al10 reported the bond strength of 4-METAcontaining adhesive resin to pure titanium decreased considerably after thermocycling. Jemt and Linden11 also reported that implant-supported prostheses with machined titanium have demonstrated bonding problems between the machined surface and the PMMA. Thus, conventional bonding between an acrylic resin denture base and a titanium framework may not be sufficient to prevent microleakage (Fig. 1). Several adhesive primers, including Meta Base M (containing 4-META monomer) (Sun Medical, Kyoto, Japan) and Cesead Opaque primer (containing 10-methacryloxydecyl dihydrogen phosphate [MDP]) (Kuraray, Osaka, Japan), have been developed and are commercially available for resin-bonded prostheses, composite-veneered prostheses and removable prostheses. Studies have reported that a composite veneering material had greater bond strength to Co-Cr alloy and titanium primed with Opaque primer.12,13 Metal Primer II (GC Corp, Tokyo, Japan), which uses methacryloyloxyalkyl thiophosphate derivative (MEPS) monomer, was developed to improve bond strengths to titanium compared with those found for conventional Metal Primer (GC Corp). Although several studies12-15 have been conducted on the adhesive properties of conventional Metal Primer to titanium, little is known about those of new Metal Primer II. The Siloc bonding system (Heraeus Kulzer, Irvine, Calif.) also has been developed to achieve a chemical-micromechanical bond between veneered materials, such as Artglass (Heraeus Kulzer) and Dentacolor (Heraeus Kulzer), or PMMA and dental alloys. However, this method requires not only the application of a coating, but also heat treatment to activate the coating agent. An experimental primer
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B
Fig. 1. A, Detachment of denture base resin from cast CP titanium framework. B, Dye penetration at internal finish line.

(Kanebo, Tokyo, Japan), consisting of 10-epithiodecyl methacrylate (EP8MA) in acetone, was developed as a bonding promoter for precious metal alloys.16 Watanabe et al13 reported that the bond strength and durability of veneered composite to CP titanium improved with this primer and with Opaque primer. Many studies have evaluated the adhesion of composite to CP titanium with these adhesive primers, and high bond strengths were recorded.12-14,17-22 However, few studies have evaluated the adhesion of denture base resin to primed CP titanium for RPDs.23-25 In particular, no studies have been reported on the evaluation of the bond strengths of PMMA to titanium primed with Metal Primer II, the Siloc bonding system, or the experimental primer used in this study. Moreover, few studies have compared adhesion using a primer on CP titanium, Ti-6Al-4V, or Co-Cr alloy. The purpose of this study was to examine the shear bond strengths of an autopolymerizing acrylic resin as a denture base resin to cast CP titanium and Ti-6Al-4V alloy using various adhesive primers. These results were compared with those obtained with a Co-Cr alloy. In addition, the surface structure and composition of the
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Table I. Materials used for this study

Material Identification Manufacturer Composition

Metal

Primer

PMMA

CP titanium ASTM Grade II Ti-6AL-4V ASTM Grade V Co-Cr alloy Vitallium Metal Primer II (MP) Cesead Opaque Primer (OP) Meta Base M (MB) Experimental Primer (EP) Siloc Bonding System (SI) Palapress Vario

Titanium Industries, Grand Prairie, Texas Titanium Industries Austenal, Chicago, Ill. GC Corp, Tokyo, Japan Kuraray, Osaka, Japan Sun Medical, Kyoto, Japan Kanebo, Tokyo, Japan Heraeus Kulzer, Irvine, Calif. Heraeus Kulzer, Irvine, Calif.

Ti>99.0% Ti>89.0%, 6.0% Al, 4.0% V Co 60.6%, Cr 31.5%, Mo 6.0% Metacryloyloxyalkyl thiophosphate derivatives (MEPS) 10-methacryloyloxydecyl dihydrogen phosphate (MDP) 4-metacryloxyethyl trimelitate anhydride (4-META) 10-epithiodecyl methacrylate (EP8MA)16 Methacryloxypropyl trimethoxysilane Methylmethacrylate dimethacrylate

3 metals after grit blasting were observed, since Kern and Thompson26,27 and Fujishima et al28 showed that grit blasting changed the composition of the CP titanium surface.

MATERIAL AND METHODS

Information on the materials used for this study is presented in Table I. Disk-shaped patterns (6.0 mm in diameter and 2.5 mm thick) were cast with CP titanium (ASTM Grade II) and Ti-6Al-4V alloy (ASTM Grade V), using magnesia-based investment (Selevest CB, Selec Co, Osaka, Japan) in an arc-melting centrifugal casting machine (Ticast Super R, Selec Co), in accordance with the manufacturers instructions. For comparison, disk patterns of a Co-Cr alloy (Vitallium [original], Austenal, Chicago, Ill.) were conventionally cast using a silica-based investment (V.R. Investment system, Austenal) in an induction casting machine (ECM III, Nobel Biocare Inc, Chicago, Ill.). Sixty cast disks were made for each alloy, for a total of 180 specimens. After casting, the disk surfaces were finished with No. 600 SiC abrasive paper under water and with 50 m grain-sized aluminum oxide (alumina) for 10 seconds, using a grit blaster (Micro Blaster, Comco Inc, Burbank, Calif.). The emission pressure was 0.48 MPa with the nozzle positioned approximately 5 mm from the surface of the metal adherent. The grit-blasted cast disks were washed in acetone for 10 minutes with ultrasonic agitation (Branson 2200, Branson Ultrasonic Corp, Danbury, Conn.).

ating voltage, 20 kV; beam current, 1 nA; live time, 120 seconds; dead time, 25% to 35%; take-off angle, 30 degrees; and spot size, 120 90 m. The quality of the spectrum analysis was checked by analytical software (Voyager system, Noran Instruments, Middleton, Wis.), with chi-squared fit parameter values for the match in the range of 1 to 10. Elemental compositions for 5 randomly chosen areas (1000) were determined on each of the 5 specimens for all metals tested. Surface roughness (Ra) on the grit-blasted surfaces was measured with a surface roughness profilometer (Surftest-402 series 178, Mitsutoyo, Tokyo, Japan), which had a cut-off (the specified value correlates to the peak-to-valley height) of 0.8 c (wavelength corresponding to 75% of the amplitude to obtain the filterable surface roughness values by eliminating the undulation element from an uneven surface) and measurement length of 5 mm. The average roughness was obtained from 5 disks on which 3 random areas were measured and averaged.

Shear testing
Four of the 5 adhesive primers (Metal Primer II [MP]; Cesead Opaque primer [OP]; Meta Base M [MB]; experimental primer [EP]) were applied to the grit-blasted surface with a brush-on technique. For the Siloc Bonding System (SI), the pretreatment agent (Siloc Pre) was applied to the surface in a uniform coating before application of the primer. The wetted surface was air-dried for 2 minutes and then placed in an activation chamber (Heraeus Kulzer Inc, Irvine, Calif.) according to the manufacturers instructions. After the surface had cooled for 4 minutes, Siloc Bond was applied. As a control, unprimed disk surfaces were also prepared. A piece of double-stick tape with a 5-mm diameter hole was placed on the bonding surface of each cast disk to define the area of the bond. A Teflon ring (2 mm thick) with a circular hole (6 mm in diameter) was positioned over the tape. An autopolymerizing PMMA resin (Palapress Vario, Heraeus Kulzer, Inc) was mixed and poured to fill the inside of the Teflon ring. Polymerization was performed according to manVOLUME 83 NUMBER 1

Observation of metal surfaces

Surface structure of the grit-blasted disks was observed with a SEM (JSM-6300, JEOL Corp, Tokyo, Japan), with an accelerating voltage of 15 kV. To observe the remaining alumina particles on the surface, both secondary electron imaging (SEI) and backscattered electron imaging (BEI) were used. The surfaces of all metal disks before and after grit blasting were semiquantitatively examined with area analysis and an x-ray energy dispersive analyzer (XEDA) using the following parameters: working distance, 15 mm; acceler52

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Table II. Weight percentages (%) of elements on alloy surfaces before and after grit blasting
Al Si O Ti V Mo Co Cr

CP Ti Ti-6Al-4V Co-Cr

Before After Before After Before After

0.1 22.0 9.2 24.6 0.4 20.6

(0.0) (2.7) (0.6) (1.1) (0.8) (0.6)

1.8 1.0 0.5 0.9 1.3 1.5

(0.8) (0.2) (0.3) (0.1) (0.0) (0.1)

0.0 38.5 0.0 38.0 6.5 21.2

(0.0) (1.7) (0.0) (0.5) (1.3) (0.4)

98.1 (0.8) 38.5 (4.0) 86.7 (0.7) 35.0 (1.4)

3.6 (0.2) 1.5 (0.1)

8.5 (0.4) 4.5 (0.4)

51.1 (1.9) 31.8 (0.2)

32.2 (0.4) 20.3 (0.6)

One SD of mean is shown in parentheses.

Table III. Shear bond strength (MPa) and statistical results

TC0 CP Ti Ti-6Al-4V Co-Cr CP Ti TC2000 Ti-6Al-4V Co-Cr

Control Metal Primer II Cesead Opaque Primer Meta Base M Experimental Primer Siloc System

6.4 (0.8) 25.3A,B (1.4) 28.1A (2.0) 21.3C (2.0) 25.8A,B (1.1) 24.6B,C (1.6)

6.6 (0.2) 26.1A (1.5) 27.7A (1.3) 21.0B (2.4) 25.7A (2.0) 24.4A,B (3.3)

6.2 (0.7) 27.6A (2.5) 29.3A (1.2) 22.5B (0.6) 27.7A (1.9) 22.9B (2.0)

3.0 (1.2) 24.7A (2.0) 27.4A (1.6) 13.8 (0.5) 25.5A (2.2) 19.4 (3.1)

3.4 (0.9) 25.7A (1.7) 26.9A (2.9) 14.1 (0.8) 25.0A,B (2.2) 20.3B (3.3)

3.2 (0.7) 25.9A (3.7) 28.6A (3.0) 17.4B (1.6) 25.4A (1.8) 18.3B (2.7)

One SD of mean is shown in parentheses. Identical letters indicate that the values in the same column are not statistically different (P>.05). Control groups were not included in the statistical analysis.

ufacturers instructions, namely, in a pressure curing unit (Palamat, Heraeus Kulzer, Inc) at 55C and 0.2 MPa pressure for 15 minutes. After removing the Teflon ring (PTFE New Age Industries Inc, Willow Grove, Pa.), all specimens were stored in water at 37C for 24 hours. This state was defined as thermocycle 0 (baseline). To evaluate the durability of the bond, the specimens were divided into 2 groups of 5 specimens: (1) thermocycle 0 (TC0), and (2) 2000 thermocycles (TC2000) in water between 4C and 60C with a dwell time of 1 minute at each temperature.

with an optical microscope (Stereomicroscope SR, Zeiss, Oberkochen, Germany) at 20 magnification to assess the type of bond failure. The failure modes were categorized as either A (adhesive failure at the metalPMMA interface) or M (mixed adhesive and cohesive failure); no solely cohesive failure within the PMMA was observed in this study.

RESULTS Surface structure and composition

Surface roughness (Ra) of grit-blasted CP titanium, Ti-6Al-4V, and Co-Cr alloy was 1.20 0.03 m, 1.15 0.02 m, and 0.96 0.08 m, respectively. A significant difference (P<.001) was found between Co-Cr alloy and CP titanium, and between Co-Cr and Ti-6Al-4V alloys. There was no significant difference (P>.05) between CP titanium and Ti-6Al-4V. Table II shows the weight percentage of the detected elements on the surfaces of the metals, both before and after grit blasting. Grit blasting with alumina substantially increased the aluminum and oxygen on the surface, and decreased the relative amounts of the original elements in each alloy (titanium, vanadium, cobalt, and chromium). SEIs and BEIs of the grit-blasted surfaces are
53

Measurement of shear bond strength

Shear bond strengths were measured on a screwdriven mechanical testing machine (Model 1125, Instron Corp, Canton, Mass.) at a crosshead speed of 0.5 mm/min. The means and standard deviations (SD) of shear bond strength (n = 5) were calculated and statistically analyzed with 3-way analysis of variance (ANOVA). The 3 factors analyzed were primer, metal, and thermocycling. After 3-way ANOVA, 1-way ANOVA and the Scheff multiple comparison test were performed at a significance level of =.05. After testing, the fracture surfaces of the specimens were observed
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Fig. 2. Secondary electron images (SEI) and backscattered electron images (BEI) of grit-blasted surfaces, taken at 1000 (SEI and BEI views correspond to same area on each metal specimen): (A) SEI of CP Ti; (B) SEI of Ti-6Al-4V; (C) SEI of Co-Cr; (D) BEI of CP Ti; (E) BEI of Ti-6Al-4V; and (F) BEI of Co-Cr. Arrows in SEI and dark areas in BEI indicate alumina particles.

illustrated in Figure 2, A through F. The appearance of the micromechanical roughening observed among the 3 metals correlated with the surface roughness values (Ra). The CP titanium and Ti-6Al-4V alloy surfaces (Fig. 2, A and B) treated by grit blasting were rougher and more abraded, and had rounder edges, compared with the Co-Cr alloy (Fig. 2, C). Alumina particles are seen randomly embedded in the surface and are shown as dark areas in the BEI photographs (Fig. 2, D, E, and F). BEI photographs illustrate the atomic number contrast. The atomic number of Al (13) is smaller than Ti (22), Co (27) and Cr (24); therefore, the alumina particles in the BEI photographs appear dark compared with the alloys. The bright appearance of the alumina particles arises from topographic contrast.

Resin-metal shear bond strength

Means and standard deviations (SD) of the shear
54

bond strengths (MPa) to the 3 metals after 0 and 2000 thermocycles, along with the statistical comparisons of the groups, are presented in Table III. Threeway ANOVA results are summarized in Table IV. Table V presents the decrease (%) of shear bond strengths after thermocycling. Types of bond failure classified as A or M for each group of specimens are shown in Table VI. Three-way ANOVA indicated that priming, thermocycling, and 2-way interactions of priming and thermocycling were significantly different (P<.001). The application of primers significantly (P<.05) improved the shear bond strengths of PMMA resin to all metals (Table III). No significant (P>.05) differences in bond strengths were found among all the metals for either TC0 or for TC2000; however, there was a significant difference (P<.05) between the TC0 group and the TC2000 group.
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Table IV. Summary of 3-way analysis of variance for shear bond strengths
Source Degrees of freedom Sum of squares Mean square F-value P-value

Primer (a)* Metal (b) Thermocycling (c) a*b a*c b*c a*b*c Residual Total
*Five adhesive primers and an unprimed control.

5 2 1 10 5 2 10 144 179

10,970.5 23.4 363.1 71.5 208.0 0.5 16.3 560.0 12,213.3

2194.1 11.7 363.1 7.2 41.6 0.3 1.6 3.9 68.2

564.2 3.0 93.4 1.8 10.7 0.1 0.4

<.001 .053 <.001 .059 <.001 .935 .936

The specimens primed with MP, OP, and EP materials exhibited significantly higher bond strengths (P<.05) than did the specimens primed with MB primer. Table III presents mixed results for the EP and SI; statistical ties for mean values are indicated with letter code B. After thermocycling, the bond strengths of MB and SI decreased greatly; particularly, the MB primer exhibited the least durability (22.8% to 35.5% decrease). Mixed failure within the denture base resin was observed in specimens primed with OP and MP materials and the TC0 condition of the experimental primer; adhesive failure occurred in all other specimens (Table VI).

Table V. Decrease (%) of shear bond strength after thermocycling

CP Ti Ti-6AL-4V Co-Cr

Control Metal Primer II Cesead Opaque Primer Meta Base M Experimental Primer Siloc System

52.9* 2.5 2.3 35.5* 1.2 21.4*

48.7* 1.3 3.1 32.8* 2.8 17.0*

48.7* 6.1 2.6 2.8* 8.4* 20.0*

*Significant difference (P<.05) between TC0 and TC2000.

DISCUSSION
There was some correlation between the degree of roughening by grit blasting and the hardness of the metals (CP titanium: 259 22 VHN; Ti-6Al-4V: 414 15 VHN; Co-Cr: 596 52 VHN, with a load of 200 gf and a loading time of 30 seconds). Although it is tempting to conclude that the softer the metal, the rougher the grit-blasted surface, this relationship was not found for CP titanium and Ti-6Al-4V, which had no significant difference in surface roughness. It was previously reported that the bond strength was higher as the bonding surface became rougher.22 However, in our study, no correlation was found between differences in surface roughness and shear bond strengths. Grit blasting with alumina not only affected the micromechanical roughening of the surface, but it left alumina particles embedded in the surface, which was consistent with previous studies.26-28 Using BEI with the aid of XEDA, a large amount of alumina was found on each metal surface after grit blasting. A previous study24 reported the composition of the grit-blasted surfaces as 45.3 wt% alumina on CP titanium and 41.7 wt% alumina on Co-Cr alloy. A similar result was obtained in our study (Table II). Fujishima et al14 compared the bond strengths of veneered resin with CP titanium and with a pure alumina plate. Although there was greater bond strength to CP titanium than to the pure alumina
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plate when OP was applied, CP titanium had lower bond strength than pure alumina when Metal Primer (the predecessor to Metal Primer II) or a silicoating system was applied. The influence of alumina on these bonding mechanisms is not well known yet; therefore, it is necessary to improve the chemical bonds of resin to the alumina surface and to investigate the attachment strengths of alumina particles to the metal surfaces. The difference between shear bond strengths of primed and nonprimed specimens was significant (P<.001) (Table III). May et al23 suggested that shear bond strength of heat-processed PMMA bonded to the machined surface of wrought CP titanium with 110 m alumina air abrasion and silane coating was 63% greater compared with specimens with no pretreatment. Other studies24,25 reported that the application of Rocatec bonding material (ESPE GmbH, Seefeld/Oberbay, Germany) resulted in a bond strength 68% greater than the control. Application of heat-cured PMMA containing 4-META (META-DENT) demonstrated a bond strength 3.7 times greater than the control group.24,25 Siragami et al15 evaluated the tensile bond strengths of a similar resin to cast Ti-6Al-4V alloy with 3 adhesive primers. They used the original Metal Primer, MB, and OP materials and found greater bond strength compared with the untreated specimens. On the basis of the results of other studies, the use of each adhesive primer with PMMA15,23-25 or com55

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Table VI. Type of bond failure

CP Ti TC0 TC2000 TC0 Ti-6Al-4V TC2000 TC0 Co-Cr TC2000

Control Metal Primer II Cesead Opaque Primer Meta Base M Experimental Primer Siloc System

A M M A M A

A M M A A A

A M M A M A

A M M A A A

A M M A M A

A M M A A A

A, Adhesive failure at the PMMA-metal interface; M, mixture of cohesive and adhesive failure in every sample group, all 5 specimens exhibited the same general failure mode.

posite13,14,18-21 can be recommended to improve the bond strength and durability to titanium. In our study, products yielding significantly (P<.05) higher bond strengths to CP titanium and Co-Cr alloy after thermocycling were OP, MP, and EP, followed by the SI and MB (Table III). The bond strengths of OP, MP, and EP did not significantly (P<.05) decrease after thermocycling (less than a 8.4% decrease) (Table V). In the specimens primed with OP and MP, the mixed failure mode occurred after thermocycling (Table VI). However, adhesive failure occurred in specimens primed with the EP after thermocycling. This phenomenon suggested that the adhesive bond between PMMA and the 3 metals primed with OP and MP is more durable than that of the EP. Thermocycling caused a significant reduction in adhesion for some systems (Table V): MB (22.8% to 35.5% decrease), SI (17.0% to 21.4% decrease), and the control (48.7% to 52.9% decrease). This reduction suggests that the long-term stability of the bond may be problematic when the MB and SI are used. Yasuda et al7 evaluated the bonding durability of 4-META PMMA to Co-Cr alloy removable prosthodontic frameworks after an average of 5 years of normal function in 35 patients and reported that a clinically stable bond that prevented microleakage at the metalresin interface had formed between PMMA containing 4-META and the Co-Cr frameworks. In their study, adequate bond strengths of PMMA to CP titanium, Ti-6Al-4V, and Co-Cr alloy were obtained for MB,7 which is also made by the manufacturer of 4-META PMMA (META-DENT). Regarding bond strength, the use of any of the 5 primers in this study apparently would be acceptable for achieving clinically durable bonds to titanium frameworks. However, cast titanium frameworks, particularly CP titanium, are much more flexible (lower elastic modulus) compared with Co-Cr alloy. Denture deflection during use can result in debonding between the denture base resin and framework, and eventually in resin fracture. Therefore, titanium frameworks should also be designed (and fabricated) to be stiff enough so that denture deflection is kept to a minimum.
56

CONCLUSIONS
Within the limits of this study, the following conclusions were drawn: 1. A considerable number of alumina particles were found attached to all metal surfaces after grit blasting. 2. The application of any one of the 5 primers tested, regardless of the brand used, significantly improved the shear bond strengths of the denture base resin to any of the cast metals tested (CP titanium, Ti-6-Al-4V, and Co-Cr alloy). 3. After thermocycling, the specimens primed with Opaque Primer and Metal Primer II showed greater bond strength than those primed with Meta Base M and the Siloc bonding system.
We gratefully acknowledge the assistance of Dr Ronald Woody of Baylor College of Dentistry, Dallas, Texas, and Dr Masato Hotta of Asahi University School of Dentistry, Japan. Editorial assistance by Mrs Jeanne Santa Cruz is also much appreciated.

REFERENCES
1. Dunny JA, King GE. Minor connector designs for anterior acrylic resin bases: a preliminary study. J Prosthet Dent 1975;34:496-502. 2. Brown DT, Desjardins RP, Chao EY. Fatigue failure in acrylic resin retaining minor connectors. J Prosthet Dent 1987;58:329-35. 3. Sasaki M, Yasuda N, Mogi T, Ai M. Influence between metal and resin on the finishing line of cobalt-chromium denture. Part 3. Studies on finishing line structure. J Jpn Prosthodont Soc 1994;38:191-7. 4. Jacobson TE. The significance of adhesive denture base resin. Int J Prosthodont 1989;2:163-72. 5. Jacobson TE, Chang JC, Keri PP, Watanabe LG. Bond strength of 4-META acrylic resin denture base to cobalt chromium alloy. J Prosthet Dent 1988;60:570-6. 6. Yasuda N, Sasaki M, Mogi T, Ai M, Nakabayashi N. Influence between metal and resin on the finishing line of cobalt-chromium denture. Part 2. Effect of 4-META on preventing dye penetration at the finishing line. J Jpn Prosthodont Soc 1978;22:525-31. 7. Yasuda N, Sasaki M, Shinogaya T, Ai M, Nakabayashi N. Influence between metal and resin on the finishing line of cobalt-chromium denture. Part 7. A clinical evaluation of 4-META system: a five-year report. J Jpn Prosthodont Soc 1985;29:761-5. 8. Kononen M, Rintanen J, Waltimo A, Kempainen P. Titanium framework removable partial denture used for patients allergic to other metals: a clinical report and literature review. J Prosthet Dent 1995;73:4-7. 9. Yamauchi M, Sakai M, Kawano J. Clinical application of pure titanium for cast plate dentures. Dent Mater J 1988;7:39-47. 10. Matsumura H, Kojima K, Kadoma Y, Masuhara E. Studies on dental selfcuring resins (26). Effect of 4-META and 4-MET addition to the MMATBBO resin. [in Japanese] Shika Zairyo Kikai 1984;3:480-9. 11. Jemt T, Linden B. Fixed implant-supported prostheses with welded titanium frameworks. Int J Periodontics Restorative Dent 1992;12:177-84.

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12. Yoshida K, Taira Y, Matsumura H, Atsuta M. Effect of adhesive metal primers on bonding a prosthetic composite resin to metals. J Prosthet Dent 1993;69:357-62. 13. Watanabe E, Watanabe I, Hotta M, Sekine I, Nakajima H, Atsuta M, et al. Bond strength of laboratory-cured prosthetic composite to primed metal surface. Third International Congress on Dental Materials (abstract) 1997:231. 14. Fujishima A, Fujimori S, Tamaki Y, Miyazaki T, Fujishima Y, Shiba A. A basic study on the fabrication of titanium veneered crown with resin composites. (Part 2). Effect of surface treatments on bonding of resin composites with titanium. J Jpn Dent Mater 1995;14(special issue):78-9. 15. Shiragami N, Kozono Y, Morikawa M. Bond of resin materials to titanium. Part 1. Effects of surface treatment. J Jpn Prosthodont Soc 1994;88(special issue):73. 16. Kadoma Y. Surface treatment of dental precious metal alloy by thiirane monomers having a long alkylene chain. J Jpn Dent Mater 1997;16:11421. 17. Hansson O. Strength of bond with Comspan Opaque to three silicoated alloys and titanium. Scand J Dent Res 1990;98:248-56. 18. Fujishima A, Fujishima Y, Ferracane JL. Shear bond strength of four commercial bonding systems to cp Ti. Dent Mater 1995;11:82-6. 19. Yoshida N. Clinical application of resin facing titanium crown by the nonretention method-bond strength of composite resin materials for veneering to titanium. Ohu Dent J 1997;24:1-20. 20. Hansson O, Moberg LE. Evaluation of three silicoating methods for resinbonded prostheses. Scand J Dent Res 1993;101:243-51. 21. Kern M, Thompson VP. Durability of resin bonds to pure titanium. J Prosthodont 1995;4:16-22. 22. Kurtz K, Kabcenell J, Watanabe I, Okabe T. Shear bond strength of polymer-glass to cast titanium. J Dent Res 1998;77:272, Abstract 1331.

23. May KB, Russell MM, Razzoog ME, Lang BR. The shear strength of polymethyl methacrylate bonded to titanium partial denture framework material. J Prosthet Dent 1993;70:410-3. 24. May KB, Fox J, Razzoog ME, Lang BR. Silane to enhance the bond between polymethyl methacrylate and titanium. J Prosthet Dent 1995; 73:428-31. 25. May KB, Van Putten MC, Bow DA, Lang BR. 4-META polymethyl methacrylate shear bond strength to titanium. Oper Dent 1997;22:37-40. 26. Kern M, Thompson VP. Sandblasting and silica-coating of dental alloys: volume loss, morphology and changes in the surface composition. Dent Mater 1993;9:155-61. 27. Kern M, Thompson VP. Effects of sandblasting and silica-coating procedures on pure titanium. J Dent 1994;22:300-6. 28. Fujishima A, Miyazaki T, Fujishima Y, Shiba A. Influence of sandblasting treatment with several alumina particles on the surface texture of CP titanium. J Jpn Dent Mater 1997;16:218-26. Reprint requests to: DR CHIKAHIRO OHKUBO DEPARTMENT OF BIOMATERIALS SCIENCE BAYLOR COLLEGE OF DENTISTRY 3302 GASTON AVE DALLAS, TX 75246 FAX : (214) 828 - 8458 E-MAIL: ohkubo@jadedbi.ne.jp Copyright 2000 by The Editorial Council of The Journal of Prosthetic Dentistry. 0022-3913/2000/$12.00 + 0. 10/1/103406

Noteworthy Abstracts of the Current Literature

Mandibular overdentures stabilized by Astra Tech implants with either ball attachments or magnets: 5-year results Davis DM, Packer ME. Int J Prosthodont 1999;12:222-9.

Purpose. This study reported 5-year results of patients treated with implant-stabilized overdentures in the mandible with the use of either magnets or ball attachments from a continuing prospective study. Material and methods. A total of 25 edentulous patients participated in this prospective study. Thirteen patients were treated with mandibular overdentures supported by 2 implants that used ball attachments (Astra Tech System) and 12 patients were treated with mandibular overdentures supported by 2 implants that used magnetic attachments (Astra Tech System). Once patients were comfortable, they were placed on annual recalls. Additional visits were initiated by the patient. Detailed records were kept for each patient visit during this 5-year follow-up and the following parameters were monitored: plaque levels, mucosal health, marginal bone levels, and the patients assessment of treatment results. Statistical analysis was performed on the clinical and radiologic data obtained. Results. There was no statistical difference between the 2 patient groups for mucosal health or postinsertion maintenance. Magnet group patients has more plaque retention on abutment surfaces. Statistical analysis of the patients subjective analysis of treatment results showed that patients in the magnetic group were less comfortable and chewing was less effective. Conclusion. The authors concluded that either ball or magnet attachments to Astra Tech implants in the mandible were viable treatment options. Both attachment systems provided patient satisfaction; however, patients seemed to prefer the ball attachments. 24 References. RP Renner

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