Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 1735
  • Home
  • Print this page
  • Email this page


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 19  |  Issue : 1  |  Page : 91

Investigation of the effect of bonding factors on strength of porcelain bond to soft metal alloys after application of thermal cycle


1 Department of Prosthodontics, Dental Implants Research Center, Dental Research Institue, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Prosthodontics, Dental Materials Research Center, Dental Research Institue, Isfahan University of Medical Sciences, Isfahan, Iran
3 Department of Prosthodontics, Dental Students Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Submission31-Jan-2022
Date of Acceptance24-May-2022
Date of Web Publication20-Oct-2022

Correspondence Address:
Dr. Amirhossein Fathi
Department of Prosthodontics, Dental Materials Research Center, Dental Research Institue, Isfahan University of Medical Sciences, Isfahan
Iran
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1735-3327.359328

Rights and Permissions
  Abstract 


Background: The chemical bond between the metal and the porcelain component is likely to fail in metal-porcelain restorations. This is due to the thick oxide layer that Cr–Co alloys create. This study aimed to investigate the effect of metal conditioner on controlling the oxide layer formed on the surface of the Sintron alloy and the strength of the metal–porcelain bond.
Materials and Methods: In this in vitro study, 33 samples were divided into three groups based on surface treatment (n = 11). In all three groups, an oxide layer was created. In the first group, Shofu metal conditioner, in the second group, metal conditioner of Creation, and in the third group, no metal conditioner was applied. All samples were then subjected to 3000 heat cycles between 5° and 55°C with a stop time of 5 s. The specimens were then placed in a universal testing machine for shear bond testing. A force was applied between the alloy and the porcelain by a 5 kN load cell at the speed of 1 mm/min until a fraction occurred. Intergroup comparison was made by the one-way analysis of variance followed by the Tukey's multiple comparisons test (α = 0.05).
Results: The mean shear bond strength of the first group was 34.93 MPa and the mean shear bond strength of the second group was 31.37 MPa. The mean shear bond strength of the first and the second group was significantly higher than the third group (23.37 MPa) (PV < 0.001).
Conclusion: The use of metal conditioners between ceramill Sintron alloy and porcelain (Vita VMK MASTER) led to increasing the bond strength.

Keywords: Chromium alloys, dental porcelain, metal conditioner, shear strength


How to cite this article:
Ebadian B, Fathi A, Beiranvand N. Investigation of the effect of bonding factors on strength of porcelain bond to soft metal alloys after application of thermal cycle. Dent Res J 2022;19:91

How to cite this URL:
Ebadian B, Fathi A, Beiranvand N. Investigation of the effect of bonding factors on strength of porcelain bond to soft metal alloys after application of thermal cycle. Dent Res J [serial online] 2022 [cited 2022 Dec 6];19:91. Available from: https://www.drjjournal.net/text.asp?2022/19/1/91/359328




  Introduction Top


Porcelain-fused-to-metal system is the most common indirect restoration in dentistry.[1] Precious and nonprecious metal alloys are used in this regard. Noble alloys used in the infrastructure of these restorations have an excellent bond to the porcelain, good mechanical properties, and high biocompatibility. However, due to the high price of these alloys, their uses are limited.[2]

Nickel–chrome alloys, which were cheaper than gold, were firstly introduced for partial veneers, bridges, and custom frames. However, many adverse reactions have been reported following the use of these alloys. Nickel in particular has played a major role in causing these reactions.[3] Nickel and beryllium alloys are carcinogens in animals.[4],[5] Toxic and allergic reactions and issues in metabolic processes have been reported in some cases.[6],[7] Beryllium vapors from metal spills can cause conjunctivitis, dermatitis, and bronchitis.[8],[9] Cobalt–chromium (Co–Cr) alloys were later developed to eliminate the toxic effects.[10],[11],[12]

Among nonprecious alloys for metal-porcelain restorations, Co–Cr alloys have become very popular due to their good mechanical properties, such as high coefficient of elasticity, resistance to permanent deformation, and low toxicity.[13],[14],[15]

The half-life of metal-porcelain restorations depends on various factors, including the bond strength between porcelain and the underlying metal structure.[16] Proper oxidation of the metal surface is required for a stable bond between the metal alloy and porcelain to prevent the porcelain from denaturation.[17] Nonprecious metal alloys are easily oxidized, and a thick oxide layer is formed on the alloy during porcelain production. The high thickness of the oxide layer causes problems in the bond between the porcelain and the alloy due to the formation of cracks inside the oxide layer.[18] To solve this problem, attempts have been made to modify the components of the metal alloy[19] or methods of preparing the alloy surface, such as degassing,[20] increasing the firing temperature of the porcelain opaque layer,[21] and the use of abrasives.[22]

The durability of restorations can also be affected by intraoral conditions, such as the chewing cycle and temperature changes that occur with food intake.[16] To make laboratory conditions more similar to clinical conditions, some laboratory studies have used a combination of mechanical and thermal cycles.[23],[24],[25] In general, during mechanical cycles, a force is repeatedly applied to the specimens that mimic the chewing cycles,[26] while in the thermal cycle, sudden and extreme thermal changes are applied to mimic the oral condition.[27] Another way to reinforce the bond between alloy and porcelain is to use bonding agents (metal conditioners).[28]

The most frequent issue with metal-ceramic restorations is the fracture of veneering porcelain and its chipping from metal-ceramic restorations.[29] Due to the frequency of porcelain chipping from metal-ceramic restorations according to recent clinical studies, the importance of shear bond strength between metal and porcelain has increased.[30] However, previous studies have not reached a certain solution to this issue. Hence, this study was designed to investigate and compare the effect of two different metal bonds on the shear strength of metal–porcelain bonds while the oxide layer exists on the alloy surface. The null hypothesis was that the two tested metal bonds do not affect the shear bond strength of metal–porcelain bonds.


  Materials and Methods Top


Study procedure

This in vitro study was approve in research and ethics committee of Isfahan (NO: 50545). In the present in vitro study, Co–Cr metal alloy (Sintron – Soft Metal, Amann Girrbach) was used. According to the manufacturer's instructions, 33 disk-shaped samples with a diameter of 10 mm and a thickness of 2.5 mm were milled by CAD/CAM machine (IMES-ICORE 340). The bonding surface of the metal samples was polished with silicon carbide paper with a particle size of 400 nm under heavy cooling. Then, the bonding surface of the samples was subjected to airborne-particle abrasion by 110 alumina particles at a pressure of 4 bar for 10 s with a distance of 5 mm from the nozzle of the device and an angle of 45° to the sample surface. Ultrasonic purification was then performed using isopropyl alcohol (70%), and the samples were allowed to dry at room temperature. Then, the samples were subjected to the oxidation process [Figure 1] under the recommended conditions in the furnace (Koosha Fan Pars Model: Auto term 300) at 910°C for 20 min.
Figure 1: Samples after oxidation procedure.

Click here to view


In the center of the sample's surface, which was subjected to airborne-particle abrasion, a 5 mm diameter area was created by covering the rest of the sections with adhesive tape to limit the porcelain curing area and applying a thin layer of metal conditioner. Then, the adhesive tape was removed, and the metal conditioner, which was applied on the alloy surface, was placed in the oven and cooked according to the instructions presented in [Table 1].
Table 1: Cooking program for metal conditioners and porcelains according to manufacture's instructions

Click here to view


After cooking the metal conditioner, the adhesive tape was placed on other areas of the sample surface except for the part where the metal conditioner was applied. APEC (Asia-Pacific Economic Cooperation) porcelain (Vita VMK Master) was then applied to the conditioner and cooked. Dentin porcelain was mixed with distilled water according to the manufacturer's instructions. A mold made of compressed plastic with a diameter of 5 mm and a height of 1.5 mm was placed on the APEC porcelain. Then, the mold was removed and porcelain was cooked. Finally, the porcelain went under a glazing process to complete the sample production process. The process was the same for all samples, and the only difference between the samples was in the type of applied metal conditioner. Accordingly, the samples were divided into three groups as follows:

  • Group 1: Eleven samples having oxide layers and application of metal conditioner type Shofu (Japanese)
  • Group 2: Eleven samples having oxide layers and application of metal conditioner type Creation (USA)
  • Group 3: Eleven samples having oxide layers but without applying any metal conditioners.


All samples were subjected to a thermal cycle. Each sample was immersed in ionized water for 3000 cycles at 55.5°C. It remained stationary for 1 min at each temperature and the transfer time from one temperature to the next was 30 s.

The samples were placed in an autopolymerizing resin in the universal testing machine (k-21046, Walter + bai, Switzerland) for transverse strength testing. To perform this test, a 5 kN load cell at a speed of 1 mm/min was used until a fraction occurred [Figure 2]. The force was applied parallel to the bonding surface of the samples between the alloy and the porcelain [Figure 3]. Shear bond strength (MPa) was obtained using the following formula:
Figure 2: A sample after shear bond testing and separation of porcelain from metal.

Click here to view
Figure 3: Applying a shear force parallel and close to the bonding surface of the samples between the metal and the porcelain.

Click here to view


MPa = Maximum force (N)/bonding surface (mm).

Statistical analysis

Kolmogorov-Smirnov and Levene tests were used to check the normality and the homogeneity of data, respectively. The one-way analysis of variance (ANOVA) was used to evaluate the interaction of various alloy surface modification methods on shear bond strength, and Tukey's supplementary test was used to determine the statistical differences after the ANOVA test (α = 0.05).


  Results Top


Data analysis of the present study indicated that the mean shear bond strength value was significantly different among the three study groups.

[Table 2] shows the mean, standard deviation, minimum, and maximum shear strength of samples. According to Tukey's tests, statistically significant differences were obtained for the shear strength between C and MSh samples (P = 0.001), C and MC samples (P = 0.018), and MSh and MC samples (P = 0.405).
Table 2: Mean, standard deviation, minimum, and maximum shear strength of samples

Click here to view


[Table 3] and [Table 4] compare the mean shear bond strength of the test materials between groups using the one-way ANOVA and pairwise comparison using Tukey's honest significant difference post hoc test.
Table 3: Analysis of variance

Click here to view
Table 4: Comparison of the mean shear bond strength of the test materials using one-way analysis of variance and pairwise comparison using Tukey Honestly Significant Difference post hoc test

Click here to view


[Figure 4] shows the mean shear bond strength within the three groups. The mean shear bond strength was significantly different between the three groups.
Figure 4: Mean shear bond strength (MPa) between the three groups. C: Samples without metal conditioner; Msh: Samples with Shofu metal conditioner; MC: Samples with Creation metal conditioner; SD: Standard deviation

Click here to view



  Discussion Top


The most important metal–porcelain bonding mechanisms in PFM (Porcelain Fused to Metal) restorations are van der Waals forces, micromechanical bonding forces, and chemical bonding. To establish a chemical bond between the two components, electrons must be transferred between the crystalline part of the porcelain and the metal oxide. The presence of an oxide layer is necessary to strengthen the bond between the metal and the porcelain. Where the coupling part is made of noble metals, due to the fact that these metals do not oxidize, small amounts of base and nonprecious metals (usually indium and tin) are added to the alloy, which forms an oxide layer during the firing process. On the other hand, when in these restorations, the coupling is made of base alloys, a thick oxide layer is formed, which leads to fracture during porcelain firing processes and can reduce the bond strength.[31]

In the present study, we investigated the bond strength between the metal and the porcelain in PFM restorations with chromium–cobalt alloys when/when not using metal conditioners. Both metal conditioners had a significant effect on increasing the bond strength compared to the control group.

A metal conditioner is usually a paste, powder, or liquid that is mixed together. In titanium metal restorations, it has been suggested to use metal conditioner for bonding to porcelain, but in Cr–Co metal restorations, the manufacturer's instruction is different for various kinds of ceramics. Metal conditioners of different brands have different chemical compositions, which makes them have different effects on the metal–porcelain bond. However, almost all kinds of metal conditioners reinforce the junction between the metal and the porcelain by chemical bonding. The main elements of both metal conditioners used in this study were Si and Ti. Studies have shown that the silica element in the metal conditioner compound absorbs metal oxides that form on the metal surface during porcelain, the cooking process.[32] Ti also acts as an oxygen scavenger in its composition and plays an important role in preventing the formation of an oxide layer on the metal surface during the cooking process, since cracks, formed inside the oxide layer, endanger the bonding.[18],[32],[33]

According to the results of the present study, metal conditioners that have Si and Ti in their chemical composition increase the strength of the metal–porcelain bond and control the thickness of the oxide layer.

In previous studies,[34] metal conditioners were gold-based and made for gold alloys, or that tungsten was the main component. Tungsten does not have a significant role in controlling oxide layer thickness, and its role is to prevent the oxide layer from being washed by APEC porcelain and make the oxide layer hard and impermeable.

In some studies on titanium alloy restorations, it has been concluded that the use of metal conditioners on a metal surface that has already undergone the airborne-particle abrasion process increases the bond strength between the metal and the porcelain due to the significant wettability of the metal surface.[33] A characteristic of the present study was surface treatment and airborne-particle abrasion of the samples. The use of metal conditioners may also be more effective for Cr–Co metals if subjected to airborne-particle abrasion, but confirmation of this hypothesis requires further investigation in future studies.

A study by Yoo et al.[35] examined the claims of metal conditioner manufacturers that these materials are coefficient of thermal expansion (CTE) balancing agents and confirmed that if Cr–Co and porcelain are selected in a way that their CTEs are not compatible, the higher bond strength will be obtained in the group that used metal conditioner. The bond strength between the metal and the porcelain in PFM restorations, according to ISO 9693, is higher than 25 MPa and the mean bond strength obtained is lower than this value in the group that did not use metal conditioner. Therefore, it is likely that the use of metal conditioner is essential in restorations with metal base (specifically in this study, soft metal chrome cobalt alloy).

Another factor that influences the success of porcelain-metal restorations is the resistance of the metal–porcelain bond to thermal, mechanical, and chemical stresses in the mouth. In this study, the simulation of thermal stresses in the mouth by placing samples in thermal cycles has been performed. Totally, 3000 thermal cycles were applied to the samples, which is approximately equivalent to 2.5 years.[25]

There are many methods for measuring the bond strength, the best of which is the shear test, flexural 3 points, and flexural 4 points. The shear test was chosen because it exerts a force on the area of the initial contact between the metal and the porcelain and, unlike flexural tests, the coefficient of elasticity of the metal does not affect the result.[36]

The present survey was limited to the lack of complete simulation of the oral environment regarding sample shape and other characteristics and difficulty in accessing different brands of metal conditioners. Therefore, it is recommended for future studies resemble oral conditions more accurately. It is also suggested to investigate the effect of both airborne-particle abrasion and metal conditioners together on bond strength.


  Conclusion Top


According to the results of this study and considering the limitations, the use of Creation (USA) and Shofu (Japanese) metal conditioners to increase the bond strength between Ceramill Sintron and porcelain (Vita VMK Master) was approved.

Financial support and sponsorship

This study was supported by Isfahan University of Medical Sciences (Grant No: 399393)

Conflicts of interest

The authors of this manuscript declare that they have no conflicts of interest, real or perceived, financial or nonfinancial in this article.



 
  References Top

1.
Givan D. Precious metal alloys for dental applications. In: Precious Metals for Biomedical Applications. Precious metals for biomedical applications; 2014. p. 109-29.  Back to cited text no. 1
    
2.
Slokar L, Pranjić J, Carek A. Metallic materials for use in dentistry. Holist Approach Environ 2017;7:39-58.  Back to cited text no. 2
    
3.
Setcos JC, Babaei-Mahani A, Silvio LD, Mjör IA, Wilson NH. The safety of nickel containing dental alloys. Dent Mater 2006;22:1163-8.  Back to cited text no. 3
    
4.
Report on base metal alloys for crown and bridge applications: Benefits and risks. Council on Dental Materials, Instruments, and Equipment. J Am Dent Assoc 1985;111:479-83.  Back to cited text no. 4
    
5.
Chen QY, DesMarais T, Costa M. Metals and mechanisms of carcinogenesis. Annu Rev Pharmacol Toxicol 2019;59:537-54.  Back to cited text no. 5
    
6.
Brochure B. Biological effects of dental alloy components – An overview. Biocompatibility Brochure. 2017.  Back to cited text no. 6
    
7.
Chandu G, Hema B, Mahajan H, Mishra S. Dental metal allergy: An update. J Res Adv Dent 2014;3:156-63.  Back to cited text no. 7
    
8.
Mayer A, Hamzeh N. Beryllium and other metal-induced lung disease. Curr Opin Pulm Med 2015;21:178-84.  Back to cited text no. 8
    
9.
Cooper RG, Harrison AP. The uses and adverse effects of beryllium on health. Indian J Occup Environ Med 2009;13:65-76.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Vaicelyte A, Janssen C, Le Borgne M, Grosgogeat B. -chromium dental alloys: Metal exposures, toxicological risks, CMR classification, and EU regulatory framework. Crystals 2020;10:1151.  Back to cited text no. 10
    
11.
Singh A, Ramachandra K, Devarhubli AR. Evaluation and comparison of shear bond strength of porcelain to a beryllium-free alloy of nickel-chromium, nickel and beryllium free alloy of cobalt-chromium, and titanium: An in vitro study. J Indian Prosthodont Soc 2017;17:261-6.  Back to cited text no. 11
[PUBMED]  [Full text]  
12.
Elshahawy W, Watanabe I. Biocompatibility of dental alloys used in dental fixed prosthodontics. Tanta Dent J 2014;11:150-9.  Back to cited text no. 12
    
13.
Al Jabbari YS. Physico-mechanical properties and prosthodontic applications of Co-Cr dental alloys: A review of the literature. J Adv Prosthodont 2014;6:138-45.  Back to cited text no. 13
    
14.
Kim HR, Jang SH, Kim YK, Son JS, Min BK, Kim KH, et al. Microstructures and mechanical properties of Co-Cr dental alloys fabricated by three CAD/CAM-based processing techniques. Materials (Basel) 2016;9:E596.  Back to cited text no. 14
    
15.
Padrós R, Punset M, Molmeneu M, Velasco AB, Herrero-Climent M, Rupérez E, et al. Mechanical properties of cocr dental-prosthesis restorations made by three manufacturing processes. Influence of the microstructure and topography. Metals 2020;10:788.  Back to cited text no. 15
    
16.
Vojdani M, Shaghaghian S, Khaledi A, Adibi S. The effect of thermal and mechanical cycling on bond strength of a ceramic to nickel-chromium (Ni-Cr) and cobalt-chromium (Co-Cr) alloys. Indian J Dent Res 2012;23:509-13.  Back to cited text no. 16
[PUBMED]  [Full text]  
17.
Hegedus C, Daróczi L, Kökényesi V, Beke DL. Comparative microstructural study of the diffusion zone between NiCr alloy and different dental ceramics. J Dent Res 2002;81:334-7.  Back to cited text no. 17
    
18.
Eliasson A, Arnelund CF, Johansson A. A clinical evaluation of cobalt-chromium metal-ceramic fixed partial dentures and crowns: A three- to seven-year retrospective study. J Prosthet Dent 2007;98:6-16.  Back to cited text no. 18
    
19.
Sarantopoulos DM, Beck KA, Holsen R, Berzins DW. Corrosion of CoCr and NiCr dental alloys alloyed with palladium. J Prosthet Dent 2011;105:35-43.  Back to cited text no. 19
    
20.
Wu Y, Moser JB, Jameson LM, Malone WF. The effect of oxidation heat treatment of porcelain bond strength in selected base metal alloys. J Prosthet Dent 1991;66:439-44.  Back to cited text no. 20
    
21.
Trindade FZ, Anami LC, da Costa Lima JM, de Vasconcellos LG, Balducci I, Júnior LN, et al. The effect of a bonding agent and thermo-mechanical cycling on the bond strength of a glass-ceramic to gold and cobalt-chromium alloys. Appl Adhes Sci 2014;2:1-11.  Back to cited text no. 21
    
22.
Oliveira de Vasconcellos LG, Silva LH, Reis de Vasconcellos LM, Balducci I, Takahashi FE, Bottino MA. Effect of airborne-particle abrasion and mechanico-thermal cycling on the flexural strength of glass ceramic fused to gold or cobalt-chromium alloy. J Prosthodont 2011;20:553-60.  Back to cited text no. 22
    
23.
Oyafuso DK, Ozcan M, Bottino MA, Itinoche MK. Influence of thermal and mechanical cycling on the flexural strength of ceramics with titanium or gold alloy frameworks. Dent Mater 2008;24:351-6.  Back to cited text no. 23
    
24.
Vásquez V, Ozcan M, Nishioka R, Souza R, Mesquita A, Pavanelli C. Mechanical and thermal cycling effects on the flexural strength of glass ceramics fused to titanium. Dent Mater J 2008;27:7-15.  Back to cited text no. 24
    
25.
Fischer J, Zbären C, Stawarczyk B, Hämmerle CH. The effect of thermal cycling on metal-ceramic bond strength. J Dent 2009;37:549-53.  Back to cited text no. 25
    
26.
Itinoche KM, Ozcan M, Bottino MA, Oyafuso D. Effect of mechanical cycling on the flexural strength of densely sintered ceramics. Dent Mater 2006;22:1029-34.  Back to cited text no. 26
    
27.
Rosentritt M, Behr M, van der Zel JM, Feilzer AJ. Approach for valuating the influence of laboratory simulation. Dent Mater 2009;25:348-52.  Back to cited text no. 27
    
28.
Gavelis JR, Lim SB, Guckes AD, Morency JD, Sozio RB. A comparison of the bond strength of two ceramometal systems. J Prosthet Dent 1982;48:424-8.  Back to cited text no. 28
    
29.
Aslam A, Hassan S, Nayyer M, Ahmed B. Intraoral repair protocols for fractured metal-ceramic restorations-literature review. South Afr Dent J 2018;73:35-41.  Back to cited text no. 29
    
30.
Ahmadzadeh A, Neshati A, Mousavi N, Epakchi S, Dabaghi Tabriz F, Sarbazi A. A comparison between shear bond strength of VMK master porcelain with three base-metal alloys (Ni-cr-T3, VeraBond, Super Cast) and one noble alloy (X-33) in metal-ceramic restorations. J Dent (Shiraz) 2013;14:191-6.  Back to cited text no. 30
    
31.
Li KC, Ting S, Prior DJ, Waddell JN, Swain MV. Microstructural analysis of Co-Cr dental alloy at the metal-porcelain interface: A pilot study. N Z Dent J 2014;110:138-42.  Back to cited text no. 31
    
32.
Homann F, Waddell JN, Swain MV. Influence of water, loading rate and bonder on the adhesion of porcelain to titanium. J Dent 2006;34:485-90.  Back to cited text no. 32
    
33.
Al Hussaini I, Al Wazzan KA. Effect of surface treatment on bond strength of low-fusing porcelain to commercially pure titanium. J Prosthet Dent 2005;94:350-6.  Back to cited text no. 33
    
34.
Ting S, Li KC, Waddell JN, Prior DJ, Jansen van Vuuren L, Swain MV. Influence of a tungsten metal conditioner on the adhesion and residual stress of porcelain bonded to cobalt-chromium alloy. J Prosthet Dent 2014;112:584-90.  Back to cited text no. 34
    
35.
Yoo SY, Kim SK, Heo SJ, Koak JY, Kim JG. Effects of bonding agents on metal-ceramic bond strength of Co-Cr alloys fabricated by selective laser melting. Materials (Basel) 2020;13:E4322.  Back to cited text no. 35
    
36.
de Mello CC, Bitencourt SB, Dos Santos DM, Pesqueira AA, Pellizzer EP, Goiato MC. The effect of surface treatment on shear bond strength between Y-TZP and veneer ceramic: A systematic review and meta-analysis. J Prosthod 2018;27:624-35.  Back to cited text no. 36
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

Top
 
 
Search
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed378    
    Printed10    
    Emailed0    
    PDF Downloaded49    
    Comments [Add]    

Recommend this journal