Development and status of resin composite as dental restorative materials

Clinical Difficulties Related to Direct Composite Restorations: A Multinational Survey

AIMS

Composite materials are widely used in dentistry for direct tooth restorations. However, they are highly sensitive to the working technique employed during the restorative procedure. Even minor procedural errors can have a significant impact on the quality including the longevity of the restoration. Hence the aim of this study was to determine the material preferences and analyse the clinical problems associated with direct composite restorations in a cohort of dentists.

METHODS

A 20-item online questionnaire was created in English and administered 1830 general dentists and specialists in 13 countries. The first section of the questionnaire included four questions to elicit demographic data, and the second section comprised 16 questions focused on material preferences for conservative restorations, durability of composite restorations, and the most challenging stages the dentists faced during the composite restorative procedures.

RESULTS

Respondents decided most often to use composite materials for the tooth restorations (OR 997.4, 95% CI 233.8-4254.8, P value <.001). Most respondents indicated that the durability of composite restorations was approximately 7 to 10 years (41.5%). Among the factors affecting durability, maintenance of a dry cavity was the most often reported reason (47.1%) and the foremost challenge faced by dentists (61.0%) during the composite restorative procedures.

CONCLUSIONS

Our study confirmed that resin-based composites are the most popular material for direct restoration in many countries. Although working with this material is difficult and involves multiple steps, maintaining a dry cavity during bonding, and material application may affect the therapeutic success and durability of these restorations. Clinicians need to be attentive to this issue and be prepared to adapt their decision-making and consider opting for alternative restorative materials, if appropriate.

Novel Quaternary Ammonium Urethane-Dimethacrylates for Copolymers with Low Water Sorption and Solubility

Six novel urethane-dimethacrylates with quaternary ammonium groups (QAUDMAs) were successfully synthesized from 2-(methacryloyloxy)ethyl-2-hydroxyethylmethylalkylammonium bromide (QAHAMA-n, where n was 8 and 10) and diisocyanate (isophorone diisocyanate (IPDI), 4,4'-methylenedicyclohexyl diisocyanate (CHMDI), and 4,4'-diphenylmethane diisocyanate (MDI)). Their chemical structures were confirmed through nuclear magnetic resonance spectroscopy (NMR) and Fourier transform infrared spectroscopy (FTIR). The refractive index (RI) and density (dm) were also determined. The novel QAUDMAs were compounded with common dental dimethacrylates and subsequently photopolymerized. The resulting copolymers, comprising QAUDMA 40 wt.%, bisphenol A glycerolate dimethacrylate (Bis-GMA) 40 wt.%, and triethylene glycol dimethacrylate (TEGDMA) 20 wt.%, were tested for water sorption (WS) and solubility (SL). The WS and SL values decreased following these orderings based on the diisocyanate: IPDI > CHMDI > MDI for WS, and MDI > CHMDI > IPDI for SL. The WS values ranged from 11.50 to 13.82 µg/mm3, and were significantly lower than the recommended maximum for dental materials, 40 µg/mm3. The SL values that met the recommended maximum, 7.5 µg/mm3, ranged from 2.67 to 6.75 µg/mm3. Only the copolymer having the QAHAMA-8- and MDI-derived QAUDMA had the SL slightly exceeding 7.5 µg/mm3, at 7.89 µg/mm3.

Degradation and ultrastructural changes of resin-based pit and fissure sealants under simulated chewing conditions

BACKGROUND

Resin-based pit and fissure sealants, used to prevent dental caries, can experience abrasive wear. This study aimed to assess the abrasive wear of experimental pit and fissure sealants (DIF) compared with the other commercial pit and fissure sealants by measuring surface roughness, volume loss, and ultrastructure after chewing simulation at different time points.

METHODS

Specimens were divided into five groups (n = 10): Clinpro™(CP), Teethmate™ White (TW), Teethmate™ Natural (TN), experimental sealant (DIF), and Filtek™ Supreme Flowable Restorative (FC). They underwent chewing simulation with 120,000, 240,000, and 360,000 strokes. Surface roughness and volume loss were measured with a profilometer, and ultrastructures were assessed using scanning electron microscope (SEM).

RESULTS

All specimens showed a significant increase in surface roughness after chewing simulation. FC had the highest roughness (p < 0.001) whereas DIF did not differ from other groups (p > 0.05). All materials experienced significant volume loss. Sealant types and chewing cycles affected volume loss, with CP showing the highest and TW the lowest (p < 0.001). SEM analysis revealed worn areas with circular or oval shapes, with CP and TN having larger diameters and TW the smallest.

CONCLUSIONS

DIF showed acceptable surface roughness and wear resistance compared to other commercial products after chewing simulation.

Physio-Mechanic and Microscopic Analyses of Bioactive Glass-Based Resin Infiltrants

This study aimed to investigate the efficacy and durability of bioactive glass-based dental resin infiltrants. Resin infiltrants were formulated by combining photoinitiated dimethacrylate monomers with three variations of bioactive glass: 45S5 Bioglass (RIS), boron-substituted (RIB), fluoride-substituted (RIF), and pure resins (PR), whereby TOOTH group (TH) and ICON (CN) served as commercial control groups. Teeth samples were prepared, and experimental and control infiltrants were applied on demineralized human-extracted teeth. All the samples were subjected to immersion in artificial saliva and pH cycling for 30 days. The samples from another group underwent tooth brushing simulation for 9600 cycles. Following artificial saliva immersion, the samples' hardness values showed that RIB had the highest values (318.44 ± 3.83) while PR (212.52 ± 9.02) had the lowest values. After immersing into the pH cycling solution, the RIF showed the highest hardness (286.86 ± 5.11), while the lowest values for the CN (143.76 ± 3.50). After the tooth brushing simulation, the teeth samples with RIB showed maximum microhardness values (312.06 ± 16.30) and the weakest for the TH (189.60 ± 6.43). The commercial and experimental enamel resin infiltrants showed almost similar results overall, with RIB demonstrating better microhardness and comparable surface roughness. In contrast, RIF proved more resistant to pH cycling, exhibited higher microhardness, and performed better in surface roughness analysis. These findings suggest that resin infiltrant materials, especially RIF, have promising potential for effectively and esthetically managing white spot lesions.

Mechanical properties of modern restorative "bioactive" dental materials - an in vitro study

This study aimed at assessing the mechanical properties and degradation of commercial bioactive materials. The bioactive materials (Activa Bioactive Restorative, Beautifil Flow Plus F00, F03, Predicta Bulk Bioactive) and composite resin Filtek Supreme Flow were submitted to flexural and diametral tensile strength tests (FS, DTS), modulus of elasticity (ME) evaluation, and analysis of aging in 70% ethanol and saliva on their hardness and sorption. The results for DTS ranged from 33.16 MPa (Beautifil Flow Plus F03) to 47.74 MPa (Filtek Supreme Flow). The highest FS was 120.40 MPa (Predicta Bulk Bioactive), while the lowest values were 86.55 MPa (Activa Bioactive Restorative). Activa Bioactive Restorative showed the lowest ME, as well as the highest water sorption both in alcohol and artificial saliva. Moreover, aging in saliva induced a significant decrease in hardness for Activa Restorative (p < .01). Alcohol storage caused a significant decrease in hardness for all materials (p < .0001). All tested materials met the basic requirements for light-curing materials in terms of DTS and FS. However, all materials showed higher sorption in alcohol than in saliva, while hardness decreased significantly after 30 days. Predicta Bulk Bioactive presented the highest mechanical parameters, initial hardness, and the lowest sorption of alcohol and saliva.

Effect of antacid gastric syrups on surface properties of dental restorative materials: an in vitro analysis of roughness and microhardness

OBJECTIVES

The aim of this in-vitro study was to evaluate the effects of antacid gastric syrups on the surface roughness and microhardness of restorative dental materials.

MATERIALS AND METHODS

Three different composite resins, nanohybrid, microhybrid and giomer, and four antacid gastric syrups were used in the study. A total of 150 samples were obtained by preparing 50 (10 mm x 2 mm) disk-shaped samples of each composite type. The composites were randomly divided into 5 subgroups and immersed in antacid syrups for 2 min every day for 28 days. The control group samples were kept in distilled water for 28 days. Surface roughness was measured at the beginning, on the 7th, 15th and 28th days using a mechanical profilometer, AFM, and SEM and microhardness was measured using a Vickers device. Shapiro-Wilk, Repeated Measures ANOVA, One-Way ANOVA, Tukey and Games-Howell tests were applied for statistical analysis.

RESULTS

After 28 days, the surface roughness of the giomer composite decreased significantly (p < 0.05). The surface roughness of microhybrid and nanohybrid composites increased slightly but not significantly (p > 0.05). Microhardness values of microhybrid and giomer composites showed a significant decrease (p < 0.05). SEM and AFM results were in agreement with the mechanical profilometer findings.

CONCLUSION

Agents such as calcium carbonate, sodium bicarbonate and magnesium carbonate in antacid gastric syrups can affect the surface properties of restorative dental materials. This may adversely affect the longevity and aesthetics of restorations.

CLINICAL SIGNIFICANCE

The study emphasizes the need for caution in restorative material selection and care protocols in patients using antacid gastric syrups.

The Effect of Polyethylene Fiber and Flowable Resin Composite on Fracture Resistance in the Restoration of Large MOD Cavities

OBJECTIVE

This in vitro study aims to evaluate the effect of placing polyethylene fibers used in large Class II MOD (mesio-occlusion-distal) cavities into different flowable resin composites and in different positions on the fracture resistance of the restoration.

MATERIALS AND METHODS

Ninety healthy human molars were used in the study. No treatment was performed on 10 of these teeth and they were used as the control group. The other 80 teeth were divided into 8 groups by opening large MOD cavities (n = 10). The groups were divided into 4 main groups according to the use of fiber strips; no fiber, placed in the buccolingual direction, placed in the mesiodistal direction, and placed in an "O" shape on all walls. Each main group was divided into two subgroups according to the use of the nanofill flowable composite or flowable short fiber resin composite (SFRC) as the base material. All teeth were aged with a thermal cycler and then fractured with a universal testing machine. Fracture types were recorded in terms of fracture strength and repairability. Kruskal-Wallis, one-way ANOVA, and Tukey post hoc tests were used to compare fracture strength values (p < 0.05).

RESULTS

The highest fracture resistance was observed in the control group (2888.67 ± 395.43 N). The control group was significantly higher than all groups except the 7th and 8th groups (p < 0.05). Among the restored groups, the highest mean fracture resistance values were observed in the 8th group (2463.92 ± 332.37 N). The 8th group was statistically significantly higher than the 1st and 2nd groups (p < 0.05). There was no statistically significant difference between any of the other restored groups (p > 0.05).

CONCLUSIONS

The application of polyethylene fiber in the treatment of teeth with large MOD cavities in different positions did not result in a significant difference in fracture resistance.

The Effects of Intensity, Exposure Time, and Distance of Polymerization Light on Vickers Microhardness and Temperature Rise of Conventional Resin-Based Composite

(1) Background: This study investigates the effects of curing light intensity, exposure time, and distance on the Vickers microhardness (VMH), hardness bottom-to-top ratio (HR), and temperature rise (TR) of conventional dental resin-based composite (RBC). (2) Materials and Methods: Specimens of one conventional RBC (Tetric EvoCeram, Ivoclar Vivadent) were cured with 12 different curing protocols (CPs), created with three different light intensities (Quartz Tungsten Halogen 300 mW/cm2, LED 650 mW/cm2, LED 1100 mW/cm2), two exposure times (20 and 40 s), and two distances of curing tip (0 and 8 mm). The VMH of top (VMH-T) and bottom (VMH-B) surfaces was measured. The hardness bottom-to-top ratio (HR) was calculated from VMH-B and VMH-T. The HR below 80% was rated as inadequate polymerization. The TR at the depth of 2 mm within the RBC was measured using a K-type thermocouple. Data were analyzed using Levene's test and the multivariate analysis of variance (MANOVA). The level of significance was set at p < 0.05. (3) Results: Exposure time and distance significantly influenced VMH-B and HR. Increased distance significantly reduced VMH-B, HR, and TR. CPs 300 mW/cm2/8 mm/20 s and 650 mW/cm2/8 mm/20 s produced inadequate polymerization (HR < 80%). Prolonged exposure time produced higher values of VMH-B and HR. The TR was significantly influenced by light intensity and distance. (4) Conclusions: Suboptimal light intensity (<800 mW/cm2) can produce inadequate polymerization at the lower side of the composite layer when used from a distance. Prolonged irradiation can improve the polymerization to a certain extent. Clinicians are advised to monitor the intensity of the LCUs in order to optimize the photopolymerization process. Caution is required when polymerizing with high-intensity curing light in direct contact with the RBC with longer exposure times than recommended.

In vitro analysis of flowable and high viscosity bulk fill composite versus conventional composite in core build up of endodontically treated teeth

This study aimed to test the load to fracture of flowable and high viscosity bulk-fill composites compared to a convetional (packable) composite used to build up pulpless teeth. 45 endodontically treated premolars were restored with fiber posts then divided into three groups (N = 15) according to the core build-up material. SDR group: (Smart Dentine Replacement), (BF): Filtek One Bulk Fill and (CC) Filtek Z350 packable composite. After core build up the teeth received full coverage crowns. Load to fracture (Newton) was recorded for each specimen. One-way ANOVA and Tukey multiple comparisons test were used. The highest load at fracture was shown by (CC) group (1067 N), followed by (BF) group (879 N), and the SDR group (838 N). One way ANOVA and Tukey's multiple comparisons test demonstrated no significant differences between CC, SDR, and BF groups (p > 0.05). The three materials showed comparable load to fracture. Further studies with simulation to occlusal forces and oral temperature are required.

The role of visual aids in the clinical success of posterior restorations: Randomized controlled clinical trial

Objective

This clinical study aimed to assess the impact of utilizing loupes and dental operating microscopes (DOM) with varying magnifications on the success of class II direct composite restorations.

Methods

A total of 130 class II, moderately deep caries teeth from 85 patients were randomly assigned to four groups: naked eye, ×3 loupe, ×5 loupe, and ×8.5 DOM. Cavities were restored with or without magnification. The restorations were evaluated according to World Dental Federation criteria at 1, 6, and 12-month intervals by previously calibrated evaluators. Cochran's Q test was used to compare paired scores across three or more time points within groups, while the Friedman test was employed to compare scores at three or more time points. Multiple comparisons were adjusted using the Bonferroni correction. The significance level was set at p < 0.05.

Results

Statistical analysis revealed no significant differences among the groups at the 1-, 6-, and 12-month follow-up periods (p > 0.05). Although not statistically significant, the magnified groups exhibited higher scores in aesthetic anatomical form, proximal form, postoperative sensitivity, periodontal response, and adjacent mucosalcriteria compared to the naked eye group.

Conclusion

Although no statistically significant difference was observed at the 12-month follow-up between restorations performed with and without magnification, the groups using magnification showed higher scores.

Assessment of Surface Roughness, Color, and Bonding Efficacy: Self-Adhesive vs. Conventional Flowable Resin

This in vitro study aimed to analyze the surface roughness (Ra) and color stability (ΔEab, ΔE00) following simulated mechanical brushing and to evaluate the microtensile (μTBS) of self-adhering resin flowable (SARF) to dentin. The selected materials were Constic, Yflow AS, and Tetric N flow (TNF/control). Thirty composite resin cylinders were fabricated for surface property evaluation. Ra and color were assessed both before and after simulated brushing. The thresholds of 50:50% perceptibility and acceptability of color differences in the evaluated resins were assessed. For μTBS analysis, fifteen molars were selected, sectioned to expose flat dentin surfaces, and restored according to the manufacturers' instructions for microtensile testing. There were statistically significant differences in Ra among the groups, with Constic exhibiting the highest Ra value (0.702 µm; p < 0.05), whereas Yflow AS presented the lowest Ra value (0.184 µm). No statistically significant difference in color was observed among the groups (p > 0.05). The 50:50% perceptibility and acceptability thresholds were set at 1.2 and 2.7 for ΔEab and 0.8 and 1.8 for ΔE 00. All the results fell within the acceptable limits. The mean μTBS values of Constic, Yflow AS, and TNF were 10.649 MPa, 8.170 MPa, and 33.669 MPa, respectively. This study revealed increased Ra and comparable color stability among all the tested composite resins after abrasion. However, the SARF exhibited lower μTBS compared to conventional using an adhesive system.

Awareness of possible complications associated with direct composite restorations: A multinational survey among dentists from 13 countries with meta-analysis

OBJECTIVES

Resin-based composites (RBCs) evolved into favoured materials for teeth restorations, marking a significant change in dental practice. Despite many advantages, RBCs exhibit various limitations in their physical and chemical properties. Therefore, we assessed the dentists' awareness of possible complications after direct composite restorations and their opinions about this material.

METHODS

The online questionnaire was created in English in May 2023. A 16-item survey was dedicated to general dentists and specialists. The first section included four questions related to demographic characteristics. The second section comprised twelve questions and focused on awareness of potential side effects of composite restorations, the most crucial advantages and disadvantages of composite resins, and the frequency of experienced clinical complications after the application of composite materials.

RESULTS

A total of 1830 dentists from 13 countries took part in the survey. Dentists most often declared awareness of low adhesion to the dentine (77.5 %) and, most rarely, solubility in oral fluids (42.6 %). Aesthetics was identified as the main advantage of composite fillings (79 %), followed by the possibility of repair (59 %) and adhesion to enamel (57 %). Polymerisation shrinkage was a major disadvantage for most countries (70 % overall). Analysing the declared potential clinical complications for all countries, statistically significant findings were obtained for marginal discolouration (OR=2.982, 95 % CI: 1.321-6.730, p-value=0.009) and borderline significance for secondary caries (OR=1.814, 95 % CI: 0.964-3.415, p-value=0.065).

CONCLUSIONS

Dentists value aesthetics and repairability but are aware of shrinkage and experience discolouration. The issue of toxicity and solubility seems to be the least known to dentists.

CLINICAL SIGNIFICANCE

Dentists should use RBCs with critical caution due to possible side effects. Despite the undoubted aesthetics of direct composite restorations, it is necessary to remember potential clinical complications such as marginal discolouration or secondary caries.

Comparative Evaluation of Fracture Resistance of Composite Core Buildup Materials: An In Vitro Study

Aim This study aimed to compare the fracture resistance of different materials used in composite core buildups, including conventional filler composite, nanofiller composite, and short fiber-reinforced composite (SFRC). Methods This in vitro study was conducted on 30 freshly extracted premolars. The teeth were treated using a uniform endodontic procedure, and Fiber Posts (REFORPOST, Angelus) were placed. The teeth were then divided into three groups and restored using different materials. Group 1 was restored using SFRC (everX Posterior, GC, Europe), Group 2 using microfiller composite (Te-Econom Flow, Ivoclar Vivadent), and Group 3 using nanofiller composite (Tetric N-Flow, Ivoclar Vivadent). The restoration materials were then light-cured for 40 seconds. The teeth were placed in a Universal Testing Machine (Instron) and a load was applied with a stainless-steel ball (4 mm diameter) until the tooth fractured. The fracture load for each tooth was recorded, and after the mechanical test, the experimental groups were examined for failure modes. Statistical analysis was performed using SPSS version 21.0 software. A one-way ANOVA test was conducted to compare more than two groups, followed by Tukey's test for post hoc pairwise comparison. Results The mean fracture resistance of the microfiller composite (346.94±44.63) was the lowest among the three groups. When analyzed using Tukey's test at p<0.05, fracture resistance was significantly higher in the SFRC, followed by nanofillers and microfiller composites. Conclusion Due to the increasing demand for aesthetic restorations in recent years, composites have become important in modern restorative dentistry. The development and implementation of composite dental restorative materials rely on a comprehensive understanding of each composite component and consideration of methods for modifying each component. As a result, the findings of this study will be beneficial in determining which material to use based on specific cases.

Post-failure analysis of model resin-composite restorations subjected to different chemomechanical challenges

OBJECTIVE

The current study aimed to evaluate the effects of different combinations of chemical and mechanical challenges on the failure load, failure mode and composition of the resulting fracture surfaces of resin-composite restorations.

METHODS

Three resin composites were used to fill dentin disks (2 mm inner diameter, 5 mm outer diameter, and 2 mm thick) made from bovine incisor roots. The model restorations, half of which were preconditioned with a low-pH buffer (48 h under pH 4.5), were subjected to diametral compression with either a monotonically increasing load (fast fracture) or a cyclic load with a continuously increasing amplitude (accelerated fatigue). The load or number of cycles to failure was noted. SEM was performed on the fracture surfaces to determine the proportions of dentin, adhesive, and resin composite.

RESULTS

Both cyclic fatigue and acid preconditioning significantly reduced the failure load and increased the proportion of interfacial failure in almost all the cases, with cyclic fatigue having a more pronounced effect. Cyclic fatigue also increased the amount of adhesive/hybrid layer present on the fracture surfaces, but the effect of acid preconditioning on the composition of the fracture surfaces varied among the resin composites.

SIGNIFICANCE

The adhesive or hybrid layer was found to be the least resistant against the chemomechanical challenges among the components forming the model restoration. Increasing such resistance of the tooth-restoration interface, or its ability to combat the bacterial actions that lead to secondary caries following interfacial debonding, can enhance the longevity of resin-composite restorations.

Synthesis of polymerizable betulin maleic diester derivative for dental restorative resins with antibacterial activity

OBJECTIVE

Bisphenol A glycidyl methacrylate (Bis-GMA) is of great importance for dental materials as the preferred monomer. However, the presence of bisphenol-A (BPA) core in Bis-GMA structure causes potential concerns since it is associated with endocrine diseases, developmental abnormalities, and cancer lesions. Therefore, it is desirable to develop an alternative replacement for Bis-GMA and explore the intrinsic relationship between monomer structure and resin properties.

METHODS

Here, the betulin maleic diester derivative (MABet) was synthesized by a facile esterification reaction using plant-derived betulin and maleic anhydride as raw materials. Its chemical structure was confirmed by 1H and 13C NMR spectra, FT-IR spectra, and HR-MS, respectively. The as-synthesized MABet was then used as polymerizable comonomer to partially or completely substitute Bis-GMA in a 50:50 Bis-GMA: TEGDMA resin (5B5T) to formulate dental restorative resins. These were then determined for the viscosity behavior, light transmittance, real-time degree of conversion, residual monomers, mechanical performance, cytotoxicity, and antibacterial activity against Streptococcus mutans (S. mutans) in detail.

RESULTS

Among all experimental resins, increasing the MABet concentration to 50 wt% made the resultant 5MABet5T resin have a maximum in viscosity and appear dark yellowish after polymerization. In contrast, the 1MABet4B5T resin with 10 wt% MABet possessed comparable shear viscosity and polymerization conversion (46.6 ± 1.0% in 60 s), higher flexural and compressive strength (89.7 ± 7.8 MPa; 345.5 ± 14.4 MPa) to those of the 5B5T control (48.5 ± 0.6%; 65.7 ± 6.7 MPa; 223.8 ± 57.1 MPa). This optimal resin also had significantly lower S. mutans colony counts (0.35 ×108 CFU/mL) than 5B5T (7.6 ×108 CFU/mL) without affecting cytocompatibility.

SIGNIFICANCE

Introducing plant-derived polymerizable MABet monomer into dental restorative resins is an effective strategy for producing antibacterial dental materials with superior physicochemical property.

Dental biomaterials redefined: molecular docking and dynamics-driven dental resin composite optimization

BACKGROUND

Dental resin-based composites are widely recognized for their aesthetic appeal and adhesive properties, which make them integral to modern restorative dentistry. Despite their advantages, adhesion and biomechanical performance challenges persist, necessitating innovative strategies for improvement. This study addressed the challenges associated with adhesion and biomechanical properties in dental resin-based composites by employing molecular docking and dynamics simulation.

METHODS

Molecular docking assesses the binding energies and provides valuable insights into the interactions between monomers, fillers, and coupling agents. This investigation prioritizes SiO2 and TRIS, considering their consistent influence. Molecular dynamics simulations, executed with the Forcite module and COMPASS II force field, extend the analysis to the mechanical properties of dental composite complexes. The simulations encompassed energy minimization, controlled NVT and NPT ensemble simulations, and equilibration stages. Notably, the molecular dynamics simulations spanned a duration of 50 ns.

RESULTS

SiO2 and TRIS consistently emerged as influential components, showcasing their versatility in promoting solid interactions. A correlation matrix underscores the significant roles of van der Waals and desolvation energies in determining the overall binding energy. Molecular dynamics simulations provide in-depth insights into the mechanical properties of dental composite complexes. HEMA-SiO2-TRIS excelled in stiffness, BisGMA-SiO2-TRIS prevailed in terms of flexural strength, and EBPADMA-SiO2-TRIS offered a balanced combination of mechanical properties.

CONCLUSION

These findings provide valuable insights into optimizing dental composites tailored to diverse clinical requirements. While EBPADMA-SiO2-TRIS demonstrates distinct strengths, this study emphasizes the need for further research. Future investigations should validate the computational findings experimentally and assess the material's response to dynamic environmental factors.

The effect of beverage temperature on the surface roughness, microhardness, and color stability of the monoshade composite resin: An in vitro study

Objective

This study assessed the impact of beverage temperature on the surface roughness, microhardness, and color stability of monoshade composite resin.

Materials and Methods

A batch of 70 monoshade composite resin specimens manufactured by Charisma Diamond ONE (Kulzer, Hanau, Germany) was prepared. Initial readings for surface roughness, microhardness, and color were recorded. The specimens were then divided into seven groupings of ten each: Distilled water (control group), Nescafe coffee at 70 °C and 5 °C, Arabic coffee at 70 °C and 37 °C, and cola at 7 °C and 24 °C. These samples underwent 30-min daily immersion in their respective beverages for a duration of 30 days. Final measurements were then taken. A non-contact profilometer was used for measuring surface roughness, a Vickers microhardness machine from Contour GT-I (Bruker Nano GmbH, Berlin, Germany) for microhardness, and a Color-Eye 7000A Spectrophotometer (X-Rite, GretagMacbeth, Michigan USA) for color stability. Statistical analyses, including repeated measure ANOVA for microhardness, roughness, and color, were executed using SPSS version 23.

Results

All beverages led to changes in composite color and properties. Notably, coffee at 70 °C resulted in significant discoloration of the composite resin surface (p < 0.0001). The beverage that most affected the surface hardness and roughness of the monoshade composite resin was cola at 7 °C (p = 0.008).

Conclusion

The inherent chemicals in beverages, coupled with their temperatures, can influence the composite properties of resin, specifically surface discoloration, hardness, and roughness. Clinicians may, therefore, consider instructing patients about the potential negative effects of these beverages.

Effects of chitosan and TiO2 nanoparticles on the antibacterial property and ability to self-healing of cracks and retrieve mechanical characteristics of dental composites

The aim of this study was to improve the self-healing properties of dental nanocomposite using nanoparticles of TiO2 and chitosan. We evaluated flexural and compressive strength, crack-healing, and self-healing lifespan after 3 months of water aging. The effect of the developed composite on cell viability and toxicity was assessed by an MTT assay on human alveolar basal epithelial cells (A549 cell line). The nanocomposite included 7.5 wt% polyurea-formaldehyde (PUF) and 0, 0.5, and 1 wt% n-TiO2 and chitosan. After the fracture, the samples were put in a mold for 1-90 days to enable healing. Then, the fracture toughness of the healed nanocomposites and the healing yield were measured. The flexural strength of the nanocomposite improved by adding 0.5 wt% n-TiO2, while the compressive strength increased after adding 0.5 wt% chitosan (p > 0.1). When these two materials were used simultaneously, the flexural strength was improved by around 2%; however, the compressive strength was unaffected. Compared to the other sample, the nanocomposite with 0.5 wt% n-TiO2 and chitosan had higher KIC-healing and self-healing efficiency. Self-healing efficacy had no significant effect of water aging over 90 days compared to one day (p > 0.1), demonstrating that the PUF nanocapsules were not damaged.

Polymerization shrinkage stress of contemporary dental composites: Comparison of two measurement methods

The aim of this study was to compare two testing methodologies employed for assessing the polymerization shrinkage stress of dental resin composites. Ten commercial resin composites were investigated (EverX Posterior & Flow; G-ænial Anterior, Posterior, A'CHORD & Universal Injectable; Filtek One Bulk Fill & Universal Restorative; SDR flow+ and Aura Bulk Fill). Photoelastic and contraction forces measurement methods were performed. The slope of the linear trendline and C-factor of specimens were calculated. The shrinkage stress values (range between: 6.4-13.4 MPa) obtained by the photoelastic method were higher for all resin composites than the values obtained by contraction forces measurements (range between 1.2-4.8 MPa). However, there was a strong linear correlation between these methods (r=0.8). The use of both investigated methods revealed important information about the shrinkage behavior of the restorative resin composites.

Mechanical and Antimicrobial Properties of Boron Nitride/Methacrylic Acid Quaternary Ammonium Composites Reinforced Dental Flowable Resins

Dental resin composites (DRCs) are commonly used to restore teeth affected by dental caries or defects. These materials must possess excellent properties to withstand the complex oral environment. The objective of this study was to prepare and characterize Boron nitride nanosheets (BNN)/ dimethyl amino hexadecyl methacrylate (DMAHDM) composites (BNN/DMA), and to evaluate them as functional fillers to enhance the mechanical and antimicrobial properties of dental resins. The BNN/DMA composites were successfully prepared under the theoretical guidance of molecular dynamics (MD), and then the physicochemical and morphological characterization of the BNN/DMA composites were carried out by using various test methods, such as FT-IR, XRD, UV-vis spectroscopy, SEM, TEM, and AFM. It was doped into the dental flowable resin in a certain proportion, and the results showed that the flexural strength (FS), elastic modulus (EM), compressive strength (CS), and microhardness (MH) of the modified resin composites were increased by 53.29, 47.8, 97.59, and 37.1%, respectively, with the addition of 0.8 wt % of BNN/DMA composite fillers. It has a good inhibition effect on Streptococcus mutans, with an inhibition rate as high as 90.43%. Furthermore, this effect persists even after one month of aging. In conclusion, the modification of flowable resins with low-concentration BNN/DMA composites favorably integrates the mechanical properties and long-term antimicrobial activity of dental resins. At the same time, they have good biocompatibility and do not affect the aesthetics. The BNN/DMA composite modified flowable resin has the potential to become a new type of antimicrobial dental restorative material.

Effect of silanization of poly (urea-formaldehyde) microcapsules on the flexural strength and self-healing efficiency of an experimental self-healing dental resin composite (An in-vitro study)

OBJECTIVES

This study investigated the impact of using γ-methacryloxypropyl trimethoxy silane (MPS) for surface silanization of poly (urea-formaldehyde) (PUF) microcapsules which enclose a healing liquid of "triethylene glycol dimethacrylate (TEGDMA) and N,N dihydroxyethyl-p-toluidine (DHEPT)" on some mechanical properties of an experimental dental composite as well as its self-healing efficiency.

METHODS

Synthesis of PUF microcapsules was done via in situ polymerization, followed by silanization with MPS silane. Silanized and non-silanized microcapsules were incorporated into a composite containing 30% polymer matrix and 70% fillers at different weight percentages (0%, 5%, 7.5% and 10%). The composite strength and elastic modulus were evaluated by Flexural testing. Fracture toughness KIc and self-healing efficiency were assessed by utilizing the "single edge notched beam" method.

RESULTS

Flexural strength of all groups containing silanized microcapsules was non-significantly different from control group without microcapsules. However, in contrast to control group, all groups containing non-silanized microcapsules displayed considerably decreased flexural strength. Adding silanized and non-silanized microcapsules didn't show a significant change in the KIc-virgin. The silanized microcapsules' groups achieved a self-healing efficiency of about 49-77% recovery in KIc-virgin compared to 38-69% for their non-silanized counterparts.

SIGNIFICANCE

In order to increase the interfacial adhesion with the polymer matrix, improve the mechanical properties, and increase the efficiency of self-healing of dental resin composite, PUF microcapsules were silanized for the first time in the dental field using MPS silane. This innovative silanized microcapsule-containing self-healing composite may hold promise for repairing the damage caused by restorative cracks and extending their service life.

Effect of different restorative systems and aging on marginal adaptation of resin composites to deep proximal margins

OBJECTIVES

To evaluate and compare the marginal integrity of different restorative systems bonded to proximal gingival dentin, and determine the consistency level of the results obtained by two in vitro methods.

MATERIALS AND METHODS

Thirty molars received occluso-mesial preparations with dentin/cementum gingival margins. They were divided into three groups and restored using different restorative systems with light-cured (Adhese Universal), self-cured (Palfique universal bond), and dual-cured (Futurabond U) adhesives. The restoration/gingival dentin interfaces were observed using scanning electron microscopy (SEM) and evaluated based on the World Dental Federation (FDI) criteria. After 10,000 thermal cycles, the marginal integrity was re-evaluated. Marginal integrity was evaluated by the percentage of continuous margin (% CM) at ×200 for SEM and as the frequency of each score within the FDI ranking.

RESULTS

No significant differences were found between the restorative systems immediately, however, the system with the light-cured adhesive had the lowest marginal integrity after aging. All tested restorative systems were adversely affected by aging. A moderate inverse correlation was identified between evaluation techniques.

CONCLUSION

The tested restorative systems utilizing self-cured and dual-cured adhesives may be preferable for achieving optimal marginal integrity when bonding to deep proximal margins, compared to the tested system with light-cured adhesive.

CLINICAL SIGNIFICANCE

When performing deep margin elevation, it is important to consider the adhesive system being used.

Modern Polymers for Dental Application

Ceramics dominate clinical procedures in modern dentistry related to the artificial replacement of teeth with fixed dental prostheses, replacing metal-based frameworks on a large scale [...].

Chemical Modification of Dental Dimethacrylate Copolymer with Tetramethylxylylene Diisocyanate-Based Quaternary Ammonium Urethane-Dimethacrylates-Physicochemical, Mechanical, and Antibacterial Properties

In this study, two novel quaternary ammonium urethane-dimethacrylates (QAUDMAs) were designed for potential use as comonomers in antibacterial dental composite restorative materials. QAUDMAs were synthesized via the reaction of 1,3-bis(1-isocyanato-1-methylethyl)benzene with 2-(methacryloyloxy)ethyl-2-decylhydroxyethylmethylammonium bromide (QA10+TMXDI) and 2-(methacryloyloxy)ethyl-2-dodecylhydroxyethylmethylammonium bromide (QA12+TMXDI). Their compositions with common dental dimethacrylates comprising QAUDMA 20 wt.%, urethane-dimethacrylate monomer (UDMA) 20 wt.%, bisphenol A glycerolate dimethacrylate (Bis-GMA) 40 wt.%, and triethylene glycol dimethacrylate (TEGDMA) 20 wt.%, were photocured. The achieved copolymers were characterized for their physicochemical and mechanical properties, including their degree of conversion (DC), glass transition temperature (Tg), polymerization shrinkage (S), water contact angle (WCA), flexural modulus (E), flexural strength (FS), hardness (HB), water sorption (WS), and water leachability (WL). The antibacterial activity of the copolymers was characterized by the minimum bactericidal concentration (MBC) and minimum inhibitory concentration (MIC) against Staphylococcus aureus and Escherichia coli. The achieved results were compared to the properties of a typical dental copolymer comprising UDMA 40 wt.%, Bis-GMA 40 wt.%, and TEGDMA 20 wt.%. The introduction of QAUDMAs did not deteriorate physicochemical and mechanical properties. The WS and WL increased; however, they were still satisfactory. The copolymer comprising QA10+TMXDI showed a higher antibacterial effect than that comprising QA12+TMXDI and that of the reference copolymer.

Effects of Water Sorption and Solubility on Degradation of Silorane and Methacrylate-Based Dental Composites

INTRODUCTION

Wet oral environment may have deleterious effects on performance of the composites due to influences of water sorption and solubility. The study evaluated the hydrolytic degradation caused because of water sorption and solubility of silorane and methacrylate-based dental composites.

METHODS

Ten disc samples (2 mm × 10 mm) were prepared. Samples were analyzed for water solubility and sorption according to ISO 4049:2000 regulations and tested for mass gain or loss following immersion in water or in artificial saliva at 1 day, 15 days, and 30 days period. Student's 't' test, repeated measures analysis of variance (ANOVA), and Tukey's post-hoc tests determined statistical significance of the experimental results with global significance set at P = 0.05.

RESULTS

Considerable sorption and solubility was observed with time in both materials on immersion. Silorane composites showed lower water sorption and solubility than methacrylate-based composite (MBC). Artificial saliva demonstrated higher sorption and solubility compared to distilled water.

CONCLUSION

Silorane composites display enhanced hydrolytic stability even after a month of immersion in contrast to conventional methacrylate-based composites (MBCs), making it a better alternative to MBC resins clinically.

Novel low-shrinkage dental resin containing microcapsules with antibacterial and self-healing properties

Dental resin restorations commonly fail because of fractures and secondary caries. The aim of this research was to synthesize a novel low-shrinkage dental resin with antibacterial and self-healing properties. The low-shrinkage dental resin was obtained by incorporating a 20 wt% anti-shrinkage mixture of an expanding monomer 3,9-diethyl-3,9-dimethylol -1,5,7,11-tetraoxaspiro[5,5] undecane and an epoxy resin monomer diallyl bisphenol A diglycidyl ether (1:1, referred as "UE") and different mass fractions of self-healing antibacterial microcapsules (0%, 2.5%, 5%, 7.5%, and 10%) were incorporated into the matrix to prepare multifunctional dental resin. Polymerization shrinkage, mechanical properties, antibacterial activity, self-healing ability, and cytotoxicity of this dental resin were evaluated. The polymerization volumetric shrinkage of resin containing 20 wt% UE and 7.5 wt% microcapsules was reduced by 30.12% (4.13% ± 0.42%) compared with control. Furthermore, it exhibited high antibacterial activity and a good self-healing efficiency of 71% without adversely affecting the mechanical property and cell viability. This novel multifunctional dental resin with low polymerization shrinkage and excellent antibacterial activity and self-healing capability has potential application as a dental resin material to decrease the incidence of fractures and secondary caries.

An In Vitro Study regarding the Wear of Composite Materials Following the Use of Dental Bleaching Protocols

Composite materials used in dental restorations are considered resistant, long-lasting and aesthetic. As the wear of restorations is an important element in long-term use, the aim of this study was to evaluate the surface condition of nanohybrid and microfilled composite resins, after being subjected to the erosive action of dental bleaching protocols. This paper reflects a comparative study between one nanofilled composite and three microfilled composites used in restorations. For each composite, three sets of samples (under the form of composite discs) were created: a control group, an "office bleach" group with discs bleached with 40% hydrogen peroxide gel, and a "home bleach" group with discs bleached with 16% carbamide peroxide gel. Wear was numerically determined as the trace and the coefficients of friction obtained using a tribometer, the ball-on-disk test method, and two balls: alumina and sapphire. For all composite groups, there were statistically significant differences between the wear corresponding to the control and bleaching groups, for both testing balls. Regarding the composite type, the largest traces were recorded for GC Gradia direct anterior, for all groups, using the alumina ball. In contrast, for the sapphire ball, 3M ESPE Filtek Z550 was characterized by the largest traces. With respect to the friction coefficients, the "office bleach" group recorded the largest values, no matter the composite or the ball type used. The 3M ESPE Valux Plus composite recorded the largest friction coefficients for the alumina ball, and 3M ESPE Filtek Z550 for the sapphire ball. Overall, the "office bleach" group was characterized by higher composite wear, compared to the "home bleach" protocol or control group. Nanofilled composite resins showed superior wear resistance to microfilled resins after undergoing a bleaching protocol.

Toward esthetically and biomechanically reliable anterior resin composite restorations: Current clinical experiences among dental practitioners in Saudi Arabia

Background: Esthetic anterior composite restorations are very challenging. They constitute a main part of the clinical practice of restoring teeth with resin composites. Distinctive variations in composite material selection and technique of application in anterior teeth exist when compared to the practice of restoring posterior teeth with resin composites. In a continuation of a previous assessment of class II resin composite practice,  a cross-sectional survey study was performed to determine the awareness of general dental practitioners in Saudi Arabia about resin composite restorations in anterior teeth and to provide evidence-based recommendations to improve their practice. Methods: A total of 500 dental practitioners from different provinces in Saudi Arabia were invited to participate in an online questionnaire which comprised four domains and included a total of sixteen questions addressing aspects regarding the selection of resin composites, cavity configuration, etching protocol, light-curing technique, liner application, application of poly-chromatic composite, as well as finishing and polishing procedures. Chi square testing and descriptive statistics were used to analyze the attained data. Results: From 250 respondents, the greatest participation was from the Eastern and Middle provinces of Saudi Arabia. Female dentists participated less than males. There was no general agreement between participants regarding the resin composite material or the employed technique of application in restoring anterior tooth defects. Respondents indicated that discoloration and hypersensitivity were the most common reasons for patient's dissatisfaction with resin composites in anterior teeth. Conclusions: Dental practitioners are highly encouraged to improve their clinical practice of restoring anterior teeth using resin composites with the focus upon continuous education programs, online webinars, and workshops.

Unveiling the mechanisms behind surface degradation of dental resin composites in simulated oral environments

Dental resin composites are widely used as restorative materials due to their natural aesthetic and versatile properties. However, there has been limited research on the degradation mechanisms of these composites in gastric acid environments, which would be common in patients with gastroesophageal reflux. This study aims to investigate the degradation behavior of dental composites immersed in simulated oral environments, including acid, saliva, and water. Mechanical and morphological properties of the composites, upon immersion in the simulated environments, were thoroughly examined using hardness testing and SEM imaging. Qualitative analyses of the ions leached from the polymer matrix and fillers were conducted using XPS and ICP-MS. In addition, the thermodynamic stability of the inorganic fillers of the composites in aqueous solutions across a wide range of pH values was theoretically studied through construction of Pourbaix diagrams. This study proposed a mechanism for composite leaching involving interactions between the matrix's hydrophilic groups and the aqueous immersion media, leading to swelling and chemical degradation of the composites. Furthermore, it was demonstrated that filler leaching was followed by ion exchange with Ca and P, resulting in the formation of hard calcified layers on the composite surface. The current findings provide valuable insights into the development of new composite materials with improved durability and resistance to degradation, especially for patients suffering from gastroesophageal reflux.

Effect of mouthwashes on the microhardness of aesthetic composite restorative materials

BACKGROUND

Mouthwashes are increasingly being used worldwide. However, these preparations are known to have a negative impact on composite resin dental restorations. In this study, we aim to evaluate the effect of mouthwashes on the microhardness of such restorations.

METHODS

Thirty specimens of Tetric N-Ceram composite were prepared. Each composite specimen was cured for 40 seconds and kept in saline solution for 24 hours at 37 °C. Baseline microhardness of each specimen was recorded using an Innovatest Vickers Micro Hardness Tester. Composite specimens were randomly placed in 20 mL of the selected mouthwashes (Colgate® Plax, Listerine® Teeth & Gum Defence, and Closeup® Antibacterial Mouthwash Cool Breeze) and stored in an incubator for 24 hours at 37 °C. Next, microhardness values were rechecked. pH measurements were recorded for each type of mouthwash using a digital pH meter.

RESULTS

Due to the acidic nature of Colgate® and Listerine®, the microhardness of the restorations decreased with these mouthwashes; Listerine® caused the greatest decrease in microhardness and had the lowest pH reading (4.34). For Closeup®, with a neutral pH (7.02), no negative effect on microhardness was found; on the contrary, due to the presence of zinc in this latter mouthwash, an increase of the microhardness was found.

CONCLUSIONS

We confirm the negative effect of acidic mouthwashes on the microhardness of composite dental restorations.

Development of Light-Polymerized Dental Composite Resin Reinforced with Electrospun Polyamide Layers

As the mechanical properties of resin-based dental composite materials are highly relevant in clinical practice, diverse strategies for their potential enhancement have been proposed in the extant literature, aiming to facilitate their reliable use in dental medicine. In this context, the focus is primarily given to the mechanical properties with the greatest influence on clinical success, i.e., the longevity of the filling in the patient's mouth and its ability to withstand very strong masticatory forces. Guided by these objectives, the goal of the present study was to ascertain whether the reinforcement of dental composite resins with electrospun polyamide (PA) nanofibers would improve the mechanical strength of dental restoration materials. For this purpose, light-cure dental composite resins were interspersed with one and two layers comprising PA nanofibers in order to investigate the influence of such reinforcement on the mechanical properties of the resulting hybrid resins. One set of the obtained samples was investigated as prepared, while another set was immersed in artificial saliva for 14 days and was subsequently subjected to the same set of analyses, namely Fourier-transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), and differential scanning calorimetry (DSC). Findings yielded by the FTIR analysis confirmed the structure of the produced dental composite resin material. They also provided evidence that, while the presence of PA nanofibers did not influence the curing process, it strengthened the dental composite resin. Moreover, flexural strength measurements revealed that the inclusion of a 16 μm-thick PA nanolayer enabled the dental composite resin to withstand a load of 3.2 MPa. These findings were supported by the SEM results, which further indicated that immersing the resin in saline solution resulted in a more compact composite material structure. Finally, DSC results indicated that as-prepared as well as saline-treated reinforced samples had a lower glass transition temperature (Tg) compared to pure resin. Specifically, while pure resin had a Tg of 61.6 °C, each additional PA nanolayer decreased the Tg by about 2 °C, while the further reduction was obtained when samples were immersed in saline for 14 days. These results show that electrospinning is a facile method for producing different nanofibers that can be incorporated into resin-based dental composite materials to modify their mechanical properties. Moreover, while their inclusion strengthens the resin-based dental composite materials, it does not affect the course and outcome of the polymerization reaction, which is an important factor for their use in clinical practice.

Effects of Dental Bleaching Agents on the Surface Roughness of Dental Restoration Materials

Background and Objectives: This study aimed to evaluate the surface roughness evolution of several finished and polished composites when bleaching materials are applied. The research was conducted on four microhybrid or nanofilled composites that are used in dental restorations. Materials and Methods: For each composite type, 5 samples were selected for control, 5 samples were subjected to the bleaching protocol "office bleach" with 40% hydrogen peroxide, and 5 other samples were subjected to the "home bleach" protocol with 16% carbamide peroxide, resulting in a total number of 60 samples. The surfaces of all the samples were tested for roughness, and the values of the most relevant parameter (Ra), were collected. Comparisons between composites and samples were performed using one-way ANOVA (in Statistical Package for Social Sciences). Results: After the bleaching protocol with 40% hydrogen peroxide gel, it was found that the roughness of the group increased considerably compared to the control group, so the highest roughness was found at GC Gradia direct anterior group, and the lowest value was registered for the 3M ESPE Valux Plus group. Following the bleaching protocol with 16% carbamide peroxide (home bleach), it was noted that the sample surfaces were not as affected. In this case, the lowest roughness was found at 3M ESPE Valux Plus group, and the highest roughness was registered for the GC G-aenial anterior group. Following the interpretation of the results, all four types of dental composites tested showed significant surface roughness differences between the groups subjected to bleaching protocols and those kept as control (p < 0.05). Conclusions: The surfaces of the samples were affected by the bleaching protocols by increasing the roughness compared to the control samples.

Assessment of Microhardness of Conventional and Bulk-Fill Resin Composites Using Different Light-Curing Intensity

(1) Background: This study evaluates the effect of a conventional/low-voltage light-curing protocol (LV protocol) (10 s with 1340 mW/cm²) and high-voltage light-curing protocol (HV protocol) (3 s with 3440 mW/cm²) on the microhardness (MH) of dental resin-based composites (RBCs). Five resin composites were tested: conventional Evetric (EVT), Tetric Prime (TP), Tetric Evo Flow (TEF), bulk-fill Tetric Power Fill (PFL), and Tetric Power Flow (PFW). (2) Materials and Methods: Two tested composites (PFW and PFL) were designed for high-intensity light curing. The samples were made in the laboratory in specially designed cylindrical molds; diameter = 6 mm and height = 2 or 4 mm, depending on the type of composite. Initial MH was measured on the top and bottom surfaces of composite specimens 24 h after light curing using a digital microhardness tester (QNESS 60 M EVO, ATM Qness GmbH, Mammelzen, Germany). The correlation between the filler content (wt%, vol%) and the MH of the RBCs was tested. For the calculation of depth-dependent curing effectiveness, the bottom/top ratio for initial MH was used. (3) Conclusions: MH of RBCs is more dependent on material composition than on light-curing protocol. Filler wt% has a greater influence on MH values compared to filler vol%. The bottom/top ratio showed values over 80% for bulk composites, while for conventional sculptable composites, borderline or suboptimal values were measured for both curing protocols.

In Vitro Optical and Physical Stability of Resin Composite Materials with Different Filler Characteristics

The objective of this study was to compare the physical and optical stability of resin composite materials with different filler characteristics. Ninety-six resin composite blocks (6 mm × 6 mm × 2 mm) were prepared using four different types of resin composite, divided into four groups. Specimens from the same material were randomly divided into four groups (n = 6) and allocated for Vickers hardness (VH), water sorption, solubility (WS/SL), and staining and aging challenges tests. One-way ANOVA showed significant differences in microhardness (p = 0.0001), WS (p = 0.0001), and SL (p = 0.003) among the tested groups. Beautifil II LS recorded the highest hardness, and CharmFil^®Flow had the lowest value. Beautifil Injectable X and II LS showed negative WS, whereas the other groups had positive values. All groups showed positive SL. Repeated measures ANOVA showed significant color parameter alteration in the tested groups (p = 0.0001). All groups showed significant color shifting after one week of the staining challenge. Repeated measures ANOVA showed a significant color parameter (p = 0.0001) and weight (p = 0.001) alteration after the aging challenge. The optical and physical stability of resin composites may vary according to filler characteristics. Clinicians should choose the composite as per the desired outcome.

BNN/TiO2 nanocomposite system-modified dental flow resins and the mechanism of the enhancement of mechanical and antibacterial properties

Robust and antibacterial dental resins are essential for repairing the shape and function of the teeth. However, an ingenious way to achieve a synergistic enhancement of these two properties is still lacking. In this work, guided by molecular dynamics (MD) calculations, a boron nitride nanosheet (BNN)/titanium dioxide (TiO2) nanocomposite system was synthesized and used to modify the dental flow resin to enhance its mechanical and antimicrobial properties. The mechanical and antimicrobial enhancement mechanisms were further explored. The modified resin demonstrated outstanding performance improvement with 88.23%, 58.47%, 82.01%, and 55.06% improvement in compressive strength (CS), microhardness (MH), flexural strength (FS), and elastic modulus (EM), respectively. Moreover, the modified resin could effectively inhibit the growth of Streptococcus mutans (S. mutans) regardless of aging in water and the inhibition rates were more than 90%. In conclusion, the modified resin is expected to be an ideal restorative material for clinical applications.

Development of Thickness-Dependent Predictive Methods for the Estimation of the CIEL*a*b* Color Coordinates of Monolithic and Layered Dental Resin Composites

Usually, dentin and enamel shades are layered in dental restorations with the purpose of mimicking the natural appearance of teeth. The main objective of this study was to develop and assess accuracy of a color-prediction method for both monolithic and layered dental resin-based composites with varying shades and under different illuminants. A total of 15 different shades of VITAPAN Excell, VITAPAN Dentine and VITA Physiodens as well as VITA Enamel of five different thicknesses (0.5-2.5 mm range) were used to manufacture monolithic and layered samples. A non-contact spectroradiometer with CIE 45∘/0∘ geometry was used to measure the color of all samples over a standard ceramic black background. Second-degree polynomial regression was used as predictive method for CIE-L*a*b* color coordinates. Performance of predictive models was tested using the CIEDE2000 total color difference formula (ΔE00), while accuracy was evaluated by comparative assessment of ΔE00 with corresponding 50:50% acceptability (AT00) and perceptibly (PT00) thresholds for dentistry. A mean color difference between measured (real) and predicted color of ΔE00=1.71, with 62.86% of the color differences below AT00 and 28.57% below PT00, was registered for monolithic samples. For bi-layered samples, the mean color difference was roughly ΔE00=0.50, with generally 100% and more than 85% of the estimations below AT00 and PT00, respectively. The predictive method allowed highly accurate color estimations for both monolithic and layered dental resin-based composites with varying thicknesses and under different illuminations. These results could be useful to maximize the clinical success of dental restorations.

Evaluation of the Effect of the Addition of Hydroxyapatite on Selected Mechanical and Tribological Properties of a Flow-Type Composite

(1) Background: The aim of the study was to determine the effect of modification with sintered hydroxyapatite (HAp) on selected mechanical and tribological properties of a flow-type composite. (2) Methods: Samples in the shapes of cuboidal beams (n = 120) and cylinders (n = 120) with the proper dimensions were prepared from a standard flow-type composite and others with the addition of 2% wt., 5% wt., and 8% wt. sintered hydroxyapatite. The bending strength, compression strength, diametral compression strength, impact resistance, hardness, and tribological properties were compared. (3) Results: In all cases, it was established that an increase in the amount of HAp caused a reduction in the bending, compression, and diametral compression strength. Increasing the amount of added HAp also reduced the impact strength, hardness, and wear resistance. However, the differences were statistically insignificant. (4) Conclusions: The addition of hydroxyapatite to a flow-type composite material worsened its mechanical and tribological properties; however, the obtained values were acceptable with 2% wt. and 5% wt. HAp.

Biomaterials and Clinical Applications of Customized Healing Abutment-A Narrative Review

Customized healing abutments have been introduced in clinical practice along with implant surgery to preserve or create natural-appearing hard and soft tissue around the implant. This provides the benefits of reducing the overall treatment time by eliminating the second stage and reducing the elapsed time of the fabrication of the final prostheses. This article aims to review the types and properties of materials used for the fabrication of customized healing abutments and their clinical applications. Articles published in English on customized healing abutments were searched in Google Scholar, PubMed/MEDLINE, ScienceDirect, and the Scopus databases up to August 2022. The relevant articles were selected and included in this literature review. Customized healing abutments can be fabricated from materials available for dental implants, including PEEK, PMMA, zirconia, resin composite, and titanium. All the materials can be used following both immediate and delayed implant placement. Each material provides different mechanical and biological properties that influence the peri-implant tissues. In conclusion, the studies have demonstrated promising outcomes for all the materials. However, further investigation comparing the effects of each material on peri-implant soft and hard tissues is required.

Accelerated Fatigue Model for Predicting Composite Restoration Failure

An empirical method is proposed to predict the clinical performance of resin composite dental restorations by using laboratory data derived from simple specimens subjected to chemical degradation and accelerated cyclic fatigue. Three resin composites were used to fill dentin disks (2-mm inner diameter, 5-mm outer diameter, and 2 mm thick) made from bovine incisor roots. The specimens (n = 30 per group) were aged with different durations of a low-pH challenge (0, 24, and 48 h under pH 4.5) before being subjected to diametral compression with either a monotonically increasing load (fast fracture) or a cyclic load with a continuously increasing amplitude (accelerated fatigue). The data from 1 material were used to establish the relationship between laboratory time (number of cycles) and clinical time to failure (years) via the respective survival probability curves. The temporal relationship was then used to predict the clinical rates of failure for restorations made of the other 2 materials, and the predictions were compared with the clinical data to assess their accuracy. Although there were significant differences in the fast fracture strength among the groups of materials or durations of chemical challenge, fatigue testing was much better at separating the groups. Linear relationships were found between the laboratory and clinical times to failure for the first material (R2 = 0.90, 0.90, and 0.62 for the 0-, 24-, and 48-h low-pH groups, respectively). The clinical life of restorations made of the other 2 materials was best predicted with data from the 48-h low-pH groups. In conclusion, an accelerated fatigue model was successfully calibrated and applied to predict the clinical failure of resin composite restorations, and the predictions based on data obtained from chemically aged specimens provided the best agreement with clinical data.

Critical Review on the Developments in Polymer Composite Materials for Biomedical Implants

There has been a lack of research for developing functional polymer composites for biomedical implants. Even though metals are widely used as implant materials, there is a need for developing polymer composites as implant materials because of the stress shielding effect that causes a lack of compatibility of metals with the human body. This review aims to bring out the latest developments in polymer composite materials for body implants and to emphasize the significance of polymer composites as a viable alternative to conventional materials used in the biomedical industry for ease of life. This review article explores the developments in functional polymer composites for biomedical applications and provides distinct divisions for their applications based on the part of the body where they are implanted. Each application has been covered in some detail. The various applications covered are bone transplants and bone regeneration, cardiovascular implants (stents), dental implants and restorative materials, neurological and spinal implants, and tendon and ligament replacement.

A Pilot Study on Monomer and Bisphenol A (BPA) Release from UDMA-Based and Conventional Indirect Veneering Composites

This study aimed to investigate the release of common monomers from conventional (Dialog Vario, Enamel Plus HFO) and UDMA-based indirect veneering composites (VITA VM LC, GC Gradia). Ten cylindrical samples of each material were prepared (n = 40), immersed in HPLC grade water, and incubated for 24 h in an incubation shaker at 37 °C and 112 rpm. Extraction was performed following ISO 10993-12 and monomers were detected and quantified by HPLC-MS/MS. In all the samples, urethane dimethacrylate (UDMA) and bisphenol A (BPA) were quantifiable. Compared to water blanks, BPA levels were only elevated in the eluates from conventional composites. In all other samples, concentrations were in the range of extraneous BPA and were therefore clinically irrelevant. Low concentrations of Bisphenol A-glycidyl methacrylate (BisGMA) were found in one BPA-free composite and in both conventional materials. Statistical analyses showed that BPA-free materials released significantly less BisGMA and no BPA, while UDMA elution was comparable to elution from conventional materials. All measured concentrations were below reported effective cytotoxic concentrations. Considering these results, the substitution of BPA-derivatives with UDMA might be beneficial since BPA-associated adverse effects are ruled out. Further studies should be enrolled to test the biocompatibility of UDMA on cells of the oral environment.

Comparative microleakage outcomes of different techniques used for creating the occlusal anatomy in occlusal direct restorations using the dental operating microscope

OBJECTIVES

Microleakage in direct dental restorations is a primary causal factor in the restoration's failure. The aim of this study was to evaluate whether the technique for occlusal layering of the composite resin (the use of brush adaptation, the use of magnification, cusp build-up, stamp technique) has any effect on microleakage of direct restorations in occlusal cavities.

MATERIALS AND METHODS

One hundred extracted human molars were restored using five restoration techniques (Packable Bulk technique, Occlusal Stamp technique, Successive Cusp Build-up technique, Successive Cusp Build-up technique + Brush adaptation, Successive Cusp Build-up technique + brush adaptation + Dental Operative Microscope magnification). The teeth were subjected to thermal aging for 800 cycles at 5°C and 55°C, infiltrated with basic fuchsin dye for 24 h, and then sectioned buccolingually in the middle of the crown. Infiltration was measured in four areas of the tooth section by five different observers and then given a score from 1 to 3, proportional to infiltration depth.

RESULTS

The lowest mean scores for infiltration (meaning less infiltration observed) were present in Group A (1.41 ± 0.878) and Group C (1.46 ± 0.679), while Group D showed the highest infiltration scores (1.75 ± 0.853). When comparing the groups for differences, no statistically significant difference in infiltration was found between any technique p < .586.

CONCLUSION

The techniques examined for placing the occlusal layer of composite in direct restorations do not differ significantly in terms of marginal infiltration, although a slight improvement was found when using the bulk technique and the successive cusp build-up.

Bulk-fill restorative composites under simulated carious and erosive conditions

Acidic conditions can cause hydrolysis and accelerate degradation of resin composites (RCs). Since there are limited and controversial data on the effect of acids on bulk-fill RCs, this study assessed the surface roughness (SR) and flexural strength (FS) of these RCs under simulated carious and erosion conditions. Bars of Filtek Bulk Fill (FBF, 3M/ESPE), X-tra fil (XTF, Voco), Tetric N-Ceram Bulk Fill (TBF, Ivoclar/Vivadent), and Aura Bulk Fill (ABF, SDI) and a conventional RC [Filtek Z350XT (FZ, 3M/ESPE)] were allocated (n=15) to undergo caries or erosion conditions. The control group was kept in artificial saliva (AS). The bars were evaluated for SR change (final-baseline) and for three-point FS. Data were analyzed using ANOVA and Tukey's test. At the baseline (p <0.001), the SR of RCs ranked as follows: (TBF = XTF) < FBF (none differed from FZ) < ABF. The interplay between RCs and conditions affected SR change (p = 0.025). While after storage in AS, there was no difference among RCs, following carious and erosive conditions, ABF showed higher SR change. For FS (p <0.001), XTF > (FBF = FZ) > (TBF = FZ) > ABF, with no difference among control, carious and erosive conditions (p = 0.148). Depending on the restorative bulk-fill RCs, carious and erosive conditions roughen the surface but do not affect the FS of these materials.

Antibacterial dental resin composites (DRCs) with synthesized bis-quaternary ammonium monomethacrylates as antibacterial agents

Three bi-quaternary ammonium methacrylates (biQAMA-12, biQAMA-14, and biQAMA-16) with different alkyl chain length were synthesized with the purpose of endowing dental resin composites (DRCs) with antibacterial activity without sacrificing physicochemical properties of DRCs. All of biQAMAs were confirmed by ¹H-NMR spectra and incorporated into Bis-GMA/TEGDMA (60 wt/40 wt) resin matrix with a mass fraction of 5 wt% as antibacterial agent. The obtained resin matrixes were mixed with commercial silaned glass fillers at a mass ratio of 30 wt/70 wt to prepare antibacterial DRCs. The double bond conversion (DC), antibacterial activity against S. mutans., surface charge density, water contact angle, water sorption (WS) and solubility (SL), mechanical properties, and cytotoxicity of biQAMAs containing DRCs were investigated. The DRC without biQAMAs was used as control. The results showed that all biQAMAs containing DRCs had antibacterial rate higher than 90%, and DRC with biQAMA-12 had the highest antibacterial rate due to its highest surface charge density. Adding 5 wt% of biQAMAs would not bring out negative effect on physicochemical properties of DRCs, except for increasing WS, but the resultant WS still met the ISO requirement on WS of restorative materials. Both biQAMA-14 and biQAMA-16 containing DRCs showed higher cytotoxicity than control, thus biQAMA-12 was considered as the optimal antibacterial agent in this research.

Effects of nanohybrid, flowable, resin-based composites on fibroblast viability using different light-curing units

PURPOSE

To investigate the in vitro cytotoxic effects of Bis-GMA-containing and Bis-GMA-free flowable resin-based composites (RBCs) on primary human gingival fibroblast cells (hGFc) using direct and indirect curing methods and three different light-curing units (LCUs) MATERIALS AND METHODS: Cells were isolated and cultured in vitro in 24-well plates. The plates were divided into treatment (cells with RBC), control (cells only), and blank (media only) groups. In the treatment groups, two types of nanohybrid flowable RBCs were used: Bis-GMA-free and Bis-GMA groups. Each treatment group was subdivided according to the curing method, i.e., direct curing (RBC was injected into the wells and cured directly on the attached cells) and indirect curing (the samples were pre-cured outside of the well plate and then added to the well plate with cells). To vary the LCU, the subgroups were further divided into three groups: multiple-emission peak light-emitting diode, single-emission peak light-emitting diode, and quartz-tungsten-halogen units. Curing was conducted for 20 s. The hGFc cytotoxicity was evaluated via 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) assay after 24, 48, and 72 h of culturing RESULTS: The MTT assay results showed that both RBCs were significantly cytotoxic toward hGFc compared to the control group (p < 0.0001). The Bis-GMA group was significantly more cytotoxic to the cells compared to the Bis-GMA-free group. In addition, the curing method and time interval affected cell viability regardless of the LCU used CONCLUSION: The Bis-GMA flowable RBC and direct curing method had the highest cytotoxic effects on hGFc regardless of the LCU used. Careful selection of flowable RBCs and proper curing techniques are required to decrease the cytotoxic effects on hGFc and improve the clinical handling of oral tissues. This article is protected by copyright. All rights reserved.

Preparation of Silica Aerogel/Resin Composites and Their Application in Dental Restorative Materials

As the most advanced aerogel material, silica aerogel has had transformative industrial impacts. However, the use of silica aerogel is currently limited to the field of thermal insulation materials, so it is urgent to expand its application into other fields. In this work, silica aerogel/resin composites were successfully prepared by combining silica aerogel with a resin matrix for dental restoration. The applications of this material in the field of dental restoration, as well as its performance, are discussed in depth. It was demonstrated that, when the ratio of the resin matrix Bis-GMA to TEGDMA was 1:1, and the content of silica aerogel with 50 μm particle size was 12.5%, the composite achieved excellent mechanical properties. The flexural strength of the silica aerogel/resin composite reached 62.9546 MPa, which was more than five times that of the pure resin. Due to the presence of the silica aerogel, the composite also demonstrated outstanding antibacterial capabilities, meeting the demand for antimicrobial properties in dental materials. This work successfully investigated the prospect of using commercially available silica aerogels in dental restorative materials; we provide an easy method for using silica aerogels as dental restorative materials, as well as a reference for their application in the field of biomedical materials.

The Effect of a Green Smoothie on Microhardness, Profile Roughness and Color Change of Dental Restorative Materials

Acidic drinks are known to exert negative effects on the surface properties of dental restorative materials. However, the effect of increasingly popular green smoothie drinks has not been addressed so far. The present study investigated the effect of cyclic immersions (5 min daily over 30 days) in a green smoothie drink on the surface properties of contemporary dental restorative materials, including resin composites, an alkasite, and a glass hybrid. Vickers microhardness, profile roughness, and perceptible color change in the CIE L* a* b* color space were evaluated as clinically relevant properties of the material surface. After 30-day green smoothie immersion, microhardness values either decreased by 8–28% (for resin composites) or increased by up to 91% (for glass hybrid). The increase in profile roughness (Ra parameter) of smoothie-immersed specimens was 7–26 times higher compared to the control group. The perceptible color change (ΔE*) in the smoothie group was 3–8 times higher compared to the control group. Overall, this study demonstrated that daily exposure of dental restorations made from resin composites, alkasites, and glass hybrid materials to a green smoothie drink can significantly accelerate material degradation, which is reflected as surface softening, as well as higher roughness and higher perceptible color change.

Deep proximal margin rebuilding with direct esthetic restorations: a systematic review of marginal adaptation and bond strength

This review aimed to characterize the effect of direct restorative material types and adhesive protocols on marginal adaptation and the bond strength of the interface between the material and the proximal dentin/cementum. An electronic search of 3 databases (the National Library of Medicine [MEDLINE/PubMed], Scopus, and ScienceDirect) was conducted. Studies were included if they evaluated marginal adaptation or bond strength tests for proximal restorations under the cementoenamel junction. Only 16 studies met the inclusion criteria and were included in this review. These studies presented a high degree of heterogeneity in terms of the materials used and the methodologies and evaluation criteria of each test; therefore, only a descriptive analysis could be conducted. The included studies were individually evaluated for the risk of bias following predetermined criteria. To summarize the results of the included studies, the type of restorative material affected the test results, whereas the use of different adhesive protocols had an insignificant effect on the results. It could be concluded that various categories of resin-based composites could be a suitable choice for clinicians to elevate proximal dentin/cementum margins, rather than the open sandwich technique with resin-modified glass ionomers. Despite challenges in bonding to proximal dentin/cementum margins, different adhesive protocols provided comparable outcomes.