Properties of packable dental composites

Monomer conversion versus flexure strength of a novel dental composite

OBJECTIVES

To quantify the monomer conversion and flexural strength of an experimental oxirane-based composite material (EXL596) compared with two, commercially available, dimethacrylate based restoratives (Z250 and Z100).

METHODS

Fourier-transform infra-red spectroscopy (FTIR) was utilised to evaluate the degree of conversion (DC) (n=5) and biaxial flexure strength (BFS) testing (n=20) was used to analyse flexural strength and associated Weibull moduli (m) of each material following 0.1, 0.5, 1, 4, 24 and 48 h immersion in a lightproof waterbath maintained at 37+/-1 degrees C.

RESULTS

The DC of Z250 and Z100 following 0.1, 0.5 and 1 h post-irradiation was significantly greater than the DC of EXL596 for the same immersion periods. This was manifested as a significant decrease in BFS and associated m of EXL596 compared with Z250 and Z100 for the 0.1, 0.5 and 1 h post-irradiation periods. The DC and BFS of EXL596 were significantly greater than Z250 and Z100 following 24 h immersion.

CONCLUSIONS

Assessment of FTIR spectra, BFS and associated m has provided a useful method in the quantitative analysis of resin-based composite conversion. Identification of the decreased DC of EXL596 compared with Z250 and Z100 was achieved using FTIR. However, decreased conversion rates within the first hour following irradiation of EXL596 may compromise flexural strength properties (associated with a decrease in BFS and m) which may be inadequate under masticatory loading.

Flexural fatigue behavior of resin composite dental restoratives

OBJECTIVE

The aim of this study was to evaluate the mechanical properties of resin composite dental restoratives under quasi-static and cyclic loading.

METHODS

Four-point-bending bars of 10 different resin composite materials were manufactured according to ISO standard and stored for two weeks in distilled water. The fracture strength (FS) was measured with the four-point-bending test in an universal testing machine. The flexural fatigue limits (FFL) for 10(5) cycles were determined under equivalent loading. All specimens were tested and fatigued in water at 37 degrees C. The data were analyzed using ANOVA, Weibull statistics of FS and the 'staircase' approach of FFL. Fractographic analysis was performed using SEM.

RESULTS

The initial flexural strength values for the resin composite materials varied from 55.4 MPa for Solitaire up to 105.2 MPa for Filtek Z250. The mean flexural fatigue limit for 10(5) cycles ranged between 37 and 67% of the initial strength. SEM analysis of the fractured surfaces suggests two kinds of failure mechanisms for initial and fatigue fracture.

SIGNIFICANCE

The fatigue behavior of resin composite materials does not correlate with initial strength values. Materials providing high initial strengths do not obviously reveal the best fatigue resistance. Flexural fatigue measurement of resin composite materials should be viewed as a useful tool to evaluate long term mechanical properties.

Cytotoxic effects of packable and nonpackable dental composites

OBJECTIVE

Advanced dental packable and nonpackable composite materials have been recently introduced onto the market as 'amalgam alternatives' for the restoration of posterior teeth. Most established composites are applied in increments of no more than 2mm and light cured to ensure complete polymerization, whereas new formulations have been claimed to be suitable for application in increments of 4-5mm. The aims of the present study were to analyze the cytotoxicity of these new composites in comparison to an established nonpackable composite using standardized cell culture systems and to examine the influence of thickness of the light cured increments on the cytotoxicity of these materials.

METHODS

Specimens were prepared in polyethylene tubes covered with mylar. All materials were light cured in 2.5 or 5mm increments with a Demetron curing light (light intensity: 550 mW/cm(2)). Specimens were added to the cultures immediately after production or after preincubation for 1, 2, 7 days or 6 weeks under cell-culture conditions. Specimens were incubated with L-929 fibroblasts for 72 h and cell numbers determined by flow cytometry. In a different series of experiments, dopaminergic cells were incubated with composite supernatants.

RESULTS

Results with L-929 fibroblasts demonstrated that all freshly prepared composite materials reduced cell numbers (p<0.05) in comparison to controls. The cytotoxicity of all substances diminished after increasing preincubation times (p<0.0001). In a rank order of cytotoxicity, the established composite and two of the advanced composite materials exhibited least cytotoxicity, whereas the other advanced composites showed moderate or severe cytotoxic effects. The cytotoxicity of each material was much higher when polymerized in 5mm increments than in 2.5mm composite increments (p<0.0001).

SIGNIFICANCE

Our data demonstrate that the advanced composites tested show similar or more severe cytotoxicity than an established nonpackable composite and that cytotoxicity of all materials investigated increases when applied in a 5mm bulk increment.

In vitro biological response to core and flowable dental restorative materials

OBJECTIVES

In vitro cytotoxicities of commercially available core and flowable dental restorative materials were assessed and compared to traditional resin composites. Our hypothesis was that the increased resin diluents added to achieve higher flow in flowables would increase cytotoxicities, whereas the higher filler content of core materials would decrease cytotoxicities relative to traditional resin composites.

METHODS

Specimens were made under aseptic conditions, then extracted into an artificial saliva solution for 0-4 weeks, to assess the effect of aging on cytotoxicity. After extraction, specimens were tested for cytotoxicity in vitro using Balb/c fibroblasts in direct contact format. Cells were exposed to the materials for 48h, after which the mitochondrial activity of the cells was measured (MTT method). Cellular activity was normalized to Teflon negative controls.

RESULTS

Core materials were uniformly and severely (<50% of Teflon cellular activity) cytotoxic initially, but several materials (Corepaste, Definite core) improved somewhat with aging in artificial saliva. Flowable materials were uniformly and severely cytotoxic with no trend toward improvement with aging. The Definite-flow was the least cytotoxic of the flowable materials, but it too was severely cytotoxic.

SIGNIFICANCE

Commercially available core and flowable restorative materials showed severe in vitro cytotoxicities that are worse than some traditional composites and most dental casting alloys and amalgams used today. Of particular note was the persistent cytotoxicity of these materials after 4 weeks of extraction with artificial saliva. These cytotoxicities indicate a continuing release of mass from these materials at levels that have biological relevance in vitro. In vivo relevance of these cytotoxicities is less clear, but these results indicate a higher biological risk for these materials compared to traditional materials that exhibit less initial toxicity and improve with aging time.

A novel filling technique for packable composite resin in Class II restorations

The use of composite resin restorations in posterior teeth has increased considerably in the past few years. Specific composite resins for posterior teeth, as well as new operative techniques, have been developed to overcome some clinical difficulties. The present article describes a new technique to reconstitute the interproximal contour and contact of Class II restorations using a packable composite resin. Two lower first molars from the same patient are reported in detail, illustrating the technique step by step. The technique indicates the use of a metallic matrix band and wood wedges to provide an interproximal contour and contact with the adjacent tooth as well as to provide an adequate cervical adaptation. The first increment of the packable composite resin is applied on the gingival wall of the proximal box, packed cervically near the axial wall and, automatically, the resin climbs up in contact with the inner surface of the matrix band. This increment is sculpted and light-cured and the metallic matrix band is removed. Thus, the Class II cavities are transformed into Class I, with free access for light-curing. Small incremental layers of composite fill the remaining cavities. This technique is faster than conventional techniques and permits appropriate embrasure, better contour, and contact points.

CLINICAL SIGNIFICANCE

Packable composite resins present primarily new handling characteristics that permit the development of novel filling techniques. The technique proposed in this article allows easier Class II buildup, with proper proximal contact and proximal smooth surfaces, once there are no irregularities among the composite increments. Another advantage is that there is adequate light exposure for polymerization, because the metal matrix can be removed during the restorative procedure.

From vulcanite to vinyl, a history of resins in restorative dentistry

This article provides historical background on the development of resin-based dental restorative materials. With an understanding of the evolution of these materials, clinicians can better appreciate both the complexity of and similarities among the wide variety of resins and polymerization techniques available today. Common problems associated with the use of resin-based materials are explained, and more advanced resin-based systems currently under development are briefly reviewed.