Effects of filler type and content on mechanical properties of photopolymerizable composites measured across two-dimensional combinatorial arrays

Microstructural investigation of hybrid CAD/CAM restorative dental materials by micro-CT and SEM

OBJECTIVES

An increasing number of CAD/CAM (computer-aided design/computer-aided manufacturing) hybrid materials have been introduced to the dental market in recent years. In addition, CAD/CAM hybrid materials for additive manufacturing (AM) are becoming more attractive in digital dentistry. Studies on material microstructures using micro-computed tomography (µ-CT) combined with scanning electron microscopy (SEM) have only been available to a limited extent so far.

METHODS

One CAD/CAM three-dimensional- (3D-) printable hybrid material (VarseoSmile Crown plus) and two CAD/CAM millable hybrid materials (Vita Enamic; Voco Grandio), as well as one direct composite material (Ceram.x duo), were included in the present study. Cylindrical samples with a diameter of 2 mm were produced from each material and investigated by means of synchrotron radiation µ-CT at a voxel size of 0.65 µm. Different samples from the same materials, obtained by cutting and polishing, were investigated by SEM.

RESULTS

The 3D-printed hybrid material showed some agglomerations and a more irregular distribution of fillers, as well as a visible layered macrostructure and a few spherical pores due to the printing process. The CAD/CAM millable hybrid materials revealed a more homogenous distribution of ceramic particles. The direct composite material showed multiple air bubbles and microstructural irregularities based on manual processing.

SIGNIFICANCE

The µ-CT and SEM analysis of the materials revealed different microstructures even though they belong to the same class of materials. It could be shown that µ-CT and SEM imaging are valuable tools to understand microstructure and related mechanical properties of materials.

Synergistic effect of ion-releasing fillers on the remineralization and mechanical properties of resin-dentin bonding interfaces

In modern restorative dentistry, adhesive resin materials are vital for achieving minimally invasive, esthetic, and tooth-preserving restorations. However, exposed collagen fibers are found in the hybrid layer of the resin-dentin bonding interface due to incomplete resin penetration. As a result, the hybrid layer is susceptible to attack by internal and external factors such as hydrolysis and enzymatic degradation, and the durability of dentin bonding remains limited. Therefore, efforts have been made to improve the stability of the resin-dentin interface and achieve long-term clinical success. New ion-releasing adhesive resin materials are synthesized by introducing remineralizing ions such as calcium and phosphorus, which continuously release mineral ions into the bonding interface in resin-bonded restorations to achieve dentin biomimetic remineralization and improve bond durability. As an adhesive resin material capable of biomimetic mineralization, maintaining excellent bond strength and restoring the mechanical properties of demineralized dentin is the key to its function. This paper reviews whether ion-releasing dental adhesive materials can maintain the mechanical properties of the resin-dentin bonding interface by supplementing the various active ingredients required for dentin remineralization from three aspects: phosphate, silicate, and bioactive glass.

Influence of surface treatment and curing mode of resin composite cements on fibroblast behavior

BACKGROUND

Human gingival fibroblast (HGF-1) cells in the connective tissue provide an effective barrier between the alveolar bone and the oral environment. Cement margins of restorations with intrasulcular preparation or cemented implant restorations are in contact with HGF cells. However, it is unknown to what extend the cement surface finish affects the behavior of HGF cells. The purpose of this study was to compare the behavior of HGF-1 cells in contact with two different resin composite cements with three different surface treatments after light-curing and autopolymerization, respectively.

METHODS

Disks of one adhesive (Multilink Automix, Ivoclar Vivadent [MLA]) and one self-adhesive (RelyX Unicem 2 Automix, 3 M [RUN]) resin composite cement were either light-cured or autopolymerized. Specimen surfaces were prepared with the oxygen inhibition layer intact, polished with P2500-grit silicon carbide paper or treated with a scaler. Cells were cultivated on the specimens for 24 h. Viability assay was performed, and cell morphology was examined with scanning electron microscopy. Additionally, roughness parameters of the specimen were analyzed with a 3D laser scanning microscope. Three-way ANOVA was applied to determine the effect of cement material, curing mode and surface treatment (a = 0.05).

RESULTS

Overall, cement material (p = 0.031), curing mode (p = 0.001), and surface treatment (p < 0.001) significantly affected relative cell viability of HGF. The autopolymerized specimen with the oxygen inhibition layer left intact displayed the lowest relative cell viability (MLA 25.7%, RUN 46.6%). Removal of the oxygen inhibition layer with a scaler increased cell viability but also resulted in higher surface roughness values.

CONCLUSIONS

HGF cell viability is affected by the surface treatment and the curing mode. The oxygen inhibition layer is an inhibitory factor for the viability of HGF cells. Autopolymerization enhances the cytotoxic potential of the oxygen inhibition layer.

Monomer release from dental restorative materials containing dimethacrylate resin after bleaching

OBJECTIVE

The aim of this study is to determine the type and amount of monomer released over time after bleaching was applied to dental restorative materials containing dimethacrylate resin.

MATERIALS AND METHODS

Thirteen different restorative materials containing dimethacrylate resin were used in this study. Twenty samples were prepared from each material and the samples were randomly divided into 4 subgroups, namely, office bleaching, home bleaching, and separate control group for each of the bleaching methods. After bleaching, the samples were stored in 75% ethanol solution for 1, 14, and 28 days. Analysis of the samples collected to determine the type and amount of residual monomer released from the materials was performed using a liquid chromatography-tandem mass/mass spectrometer (LC-MS/MS). Data were analyzed using Friedman and Kruskal-Wallis tests. Statistical significance level was taken as p < 0.05.

RESULTS

In terms of bleaching groups, mostly no significant difference was found between the groups in each time period in restorative materials (p > 0.05). In terms of time periods, it was determined that the amount of release of all monomers was decreased over time. In terms of restorative materials, the highest monomer release was detected in composite resin groups and the least monomer release was detected in CAD/CAM blocks.

CONCLUSION

Although monomers were released from all materials, bleaching did not affect the amount of released monomer. Amounts of released monomers were generally below toxic limits.

CLINICAL RELEVANCE

Within the limits of this study, bleaching does not significantly affect monomer release in restorative materials containing dimethacrylate resin.

Long-term hydrolytic stability of CAD/CAM composite blocks

This study aimed to assess water sorption and solubility of CAD/CAM composite blocks compared to CAD/CAM ceramic after 8 months storage in water and artificial saliva. Eight CAD/CAM blocks were investigated: Five resin-composite blocks (RCBs), one polymer-infiltrated ceramic network (PICN) block, one ceramic-filled polyetheretherketone (PEEK) block, and one feldspathic ceramic block. One hundred and twelve specimens were prepared comprising 14 specimens of each of the eight materials. From each group of specimens, seven randomly selected specimens were immersed in 10 mL of water, while the other seven specimens were immersed in artificial saliva. All specimens were stored at 37°C and weighed at various time intervals. The data were analysed via repeat measures ANOVA, one-way ANOVA and Tukey's post hoc test (α = 0.05 for all tests). Sorption values (mean [SD]) in water were within the range -1.21 (0.4) to 39.3 (2.1) μg/mm³ and in artificial saliva between -0.7 (0.2) and 41.6 (1.3) μg/mm³ . Solubility values in water were between -0.43 (0.08) and 0.34 (0.18) μg/mm³ and in artificial saliva between -0.53 (0.07) μg/mm³ and 0.33 (0.2) μg/mm³ . CAD/CAM composite blocks were hydrolytically stable under long-term storage (according to ISO 4949:2009), although not as stable as ceramic. Water sorption of CAD/CAM composite blocks was dependent on the resin-matrix and was influenced by the filler weight %.

The effect of different storage media on the monomer elution and hardness of CAD/CAM composite blocks

OBJECTIVE

This study aimed to assess the effect of different storage media on the hardness and monomer elution of CAD/CAM composite blocks.

METHODS

Five resin-composite blocks (RCB), one polymer-infiltrated ceramic network (PICN) block (Enamic (EN)), one ceramic-filled poly ether ether ketone (PEEK) block (Dentokeep (DK)), and one feldspathic ceramic block. Microhardness was measured using a Vickers indenter tester (FM-700, Future Tech Corp., Japan). In addition 4 conventional resin-composites were investigated for monomer elution using high performance liquid chromatography (HPLC) after storage in different media for 3 months. The data were analysed by three-way ANOVA, two-way ANOVA, one-way ANOVA, Tukey's post hoc test and the independent t-test (α=0.05 for all tests).

RESULTS

The specimens stored in the water had a hardness reduction ranging from 0.9% to 24.4%. In artificial saliva, the specimens had a hardness reduction ranging from 2.8% to 23.2%. The hardness reduction percentage in 75% Ethanol/Water (E/W) ranged between 3.8% and 35.3%. All materials, except GR (resin-composite block) and DK (Polyetheretherketone (PEEK)), showed a variable extent of monomer elution into 75% E/W with significantly higher amounts eluted from conventional composites. GRA and GND (conventional resin-composites) eluted TEGDMA in artificial saliva and GRA eluted TEGDMA in water.

SIGNIFICANCE

The hardness of CAD/CAM composite blocks was affected by different storage media, and they were not as stable as ceramic, with PICN exhibited superior hardness stability to all of the resin-composite blocks in all the storage media and was comparable to ceramic block. The hardness reduction percentage of the CAD/CAM composite blocks was influenced by the filler loading and resin-matrix composition.Minimal or no monomer elution from CAD/CAM blocks was detected.

Bioactive low-shrinkage-stress nanocomposite suppresses S. mutans biofilm and preserves tooth dentin hardness

Recurrent dental caries is one of the main reasons for resin composite restoration failures. This study aimed to: (1) develop a bioactive, low-shrinkage-stress, antibacterial and remineralizing composite and evaluate the sustainability of its antibacterial effect against Streptococcus mutans (S. mutans) biofilms; and (2) evaluate the remineralization and cariostatic potential of the composite containing nanoparticles of amorphous calcium phosphate (NACP) and dimethylaminohexadecyl methacrylate (DMAHDM), using dentin hardness measurement and a biofilm-induced recurrent caries model. The antibacterial and remineralizing low-shrinkage-stress composite consisted of urethane dimethacrylate (UDMA) and triethylene glycol divinylbenzyl ether (TEG-DVBE), 3% DMAHDM and 20% NACP. S. mutans biofilm was used to evaluate antibiofilm activity, before and after 3 months of composite aging in acidic solution. Human dentin was used to develop a recurrent caries biofilm-model. Adding DMAHDM and NACP into low shrinkage-stress composite did not compromise the flexural strength. The low-shrinkage-stress composite with DMAHDM achieved substantial reductions in biofilm colony-forming units (CFU), lactic acid production, and biofilm biomass (p < 0.05). The low-shrinkage-stress DMAHDM+NACP composite exhibited no significant difference in antibacterial performance before and after 3 months of aging, demonstrating long-term antibacterial activity. Under S. mutans biofilm acidic attack, dentin hardness (GPa) was 0.24 ± 0.04 for commercial control, and 0.23 ± 0.03 for experimental control, but significantly higher at 0.34 ± 0.03 for DMAHDM+NACP group (p < 0.05). At an instrumental compliance of 0.33 μm/N, the polymerization shrinkage stress of the new composite was 36% lower than that of a traditional composite (p < 0.05). The triple strategy of antibacterial, remineralization and lower shrinkage-stress has great potential to inhibit recurrent caries and increase restoration longevity. Statement of Significance Polymerization shrinkage stress, masticatory load over time as well as biochemical degradation can lead to marginal failure and secondary caries. The present study developed a new low-shrinkage-stress, antibacterial and remineralizing dental nanocomposite. Polymerization shrinkage stress was greatly reduced, biofilm acid production was inhibited, and tooth dentin mineral and hardness were preserved. The antibacterial composite possessed a long-lasting antibiofilm effect against cariogenic bacteria S. mutans. The new bioactive nanocomposite has the potential to suppress recurrent caries at the restoration margins, protects tooth structures, and increases restoration longevity.

Fracture strength of endodontically treated lateral incisors restored with new zirconia reinforced rice husk nanohybrid composite

Background

This study aimed to compare the fracture strength, fracture pattern and type of fracture of endodontically treated maxillary lateral incisors restored with new zirconia reinforced rice husk nanohybrid composite.

Material and Methods

Eighty mature permanent maxillary lateral incisors from patients age range of 30-60 years with single canal were selected and randomly divided into: Group 1 – RCT + nanofilled composite (Filtek), Group 2 – RCT + microhybrid composite (Zmack), Group 3 – RCT + new nanohybrid composite (Zr-Hybrid) and Group 4 - Intact teeth (control). Standardized mesio-palatal-distal cavity was prepared, and endodontic treatment was carried out using crown-down technique until size 30, tapered 0.04. Obturation was completed using single cone technique with gutta-percha and AH plus sealer. Cavity access was restored with respective composite resins. Next, teeth were stored in incubator for 24 hours and subdivided into aged and unaged subgroups. Teeth in aged subgroups were subjected to 2500 thermal cycles for 5ºC, 37ºC and 55ºC with 30 seconds dwell time and 5 seconds transfer time. After that, root surfaces of teeth were covered with silicone-based material and placed in boxes filled with acrylic until the cemento-enamel-junction (CEJ) level. They were then tested under Universal Testing Machine until fracture occurred. Samples were then viewed under Leica microscope to determine the fracture pattern and type of fracture. Data analyzed using One-way ANOVA complimented by post hoc Tukey HSD and paired sample T test for fracture strength. Fracture pattern and type of fracture were analyzed using Chi-square test. Level of significance was set at p<0.05.

Results

Significant differences were observed (p<0.05) with Group 3 demonstrating the highest fracture strength followed by Group 4, Group 1 and lastly Group 2 in both aged and unaged subgroups respectively. A significant decreased in fracture strength was noted in Group 1 and Group 2 (p<0.05) as number of thermocycle increased but no significant differences were noted in Group 3 and Group 4 (p>0.05). Besides, Group 3 and Group 4 showed higher rate of favorable fracture pattern, followed by Group 1 and lastly Group 2. Most favorable fracture pattern was noted to exhibit horizontal fracture type (86.36%), whereas most unfavorable fracture pattern exhibited vertical fracture type (77.78%).

Conclusions

Endodontically treated teeth restored with new zirconia reinforced rice husk nanohybrid composite (Zr-Hybrid) demonstrated higher fracture strength than commercialized composite resins especially after artificial ageing. Zr-Hybrid showed similar fracture pattern to those of intact teeth with higher rate of horizontal fracture type.

Key words:Fracture strength, fracture pattern, composite resin, rice husk, Zirconia.

Polymerization Shrinkage and Degree of Conversion of New Zirconia-Reinforced Rice Husk Nanohybrid Composite

Objectives  This study aimed to compare the polymerization shrinkage and degree of conversion of new zirconia-reinforced rice husk nanohybrid composite with commercialized microhybrid and nanofilled composites.

Materials and Methods  Overall, 180 samples were used for polymerization shrinkage (buoyancy and optical methods) and degree of conversion tests in which they were divided into Group 1, nanofilled composite (Filtek-Z350- XT; 3M ESPE, St Paul, MN 55144-1000, USA), Group 2, microhybrid composite (Zmack-Comp), and Group 3, nanohybrid composite (Zr-Hybrid). Polymerization shrinkage test was performed using buoyancy and optical methods. For buoyancy method, samples were weighed in air and water to calculate the shrinkage value, whereas, for optical method, images of nonpolymerized samples were captured under a digital microscope and recaptured again after light-cured to calculate the percentage of shrinkage. Degree of conversion was tested using Fourier-transform infrared spectroscopy spectrometer.

Statistical Analysis  Data were analyzed using one-way analysis of variance complemented by post hoc Dunnett’s T3 test for polymerization shrinkage and Tukey’s honestly significant difference test for degree of conversion. Level of significance was set at p < 0.05.

Results  Group 3 demonstrated similar polymerization shrinkage with Group 1, but lower shrinkage ( p < 0.05) than Group 2 based on buoyancy method. However, optical method ( p < 0.05) showed that Group 3 had the lowest shrinkage, followed by Group 1 and lastly Group 2. Besides, Group 3 showed a significantly higher degree of conversion ( p < 0.05) than Group 1 and comparable conversion value with Group 2.

Conclusions  Zirconia-reinforced rice husk nanohybrid composite showed excellent shrinkage and conversion values, hence can be considered as an alternative to commercially available composite resins.

Response of two gingival cell lines to CAD/CAM composite blocks

OBJECTIVE

This study aimed to investigate the influence of CAD/CAM composite materials on human gingival fibroblasts (HGF) and gingival keratinocytes (HGK).

METHODS

Four materials were investigated: two resin-composite blocks (RCB), Grandio Blocs (GR) and Block HC (HC); one polymer-infiltrated ceramic network (PICN) (Enamic, EN); and one conventional resin-composite, Grandioso (GND). HGF and HGK were cultured as per the supplier's protocol (ATCC, UK). Cell proliferation and cytotoxicity were evaluated at 1, 3, 5 and 10 days using LDH and Alamar Blue assays. Indirect immunostaining was used to assess the Caspase-3 activity. Data were analysed via two-way ANOVA, one-way ANOVA and Tukey's post hoc test (α = 0.05 for all tests).

RESULTS

There was significant difference in cell proliferation of the HGK and HGF cells in contact with different composite materials but no significant differences in their cytotoxicity. There was a significant effect on cell proliferation and cytotoxicity with different exposure times, for each type of resin-composite. HGF cell proliferation was higher than HGK with almost all investigated materials and at all time points. No Caspase-3 activity was detected in either cell lines.

SIGNIFICANCE

HGK proliferation and cytotoxicity appeared to be more influenced by composite materials compared to HGF, demonstrating EN cytotoxic effects in HGK. Different manufacturing techniques of resin-composites (photo curing versus heat/pressure curing) had no significant effect on their biocompatibility.

Do resin-based composite CAD/CAM blocks release monomers?

OBJECTIVE

The present study aimed to identify and quantify the elution of monomers of five different resin-based CAD/CAM blocks (RCBs) using HPLC.

METHODS

Five different RCBs were used in the study: GC Cerasmart (CS), Voco Grandio blocs (GR), 3M Lava Ultimate (LU), Shofu Block (SB), and Vita Enamic (VE). Fifteen samples from each material were prepared using a low-speed precision diamond saw (ISOMET Buehler, Lake Bluff, IL, USA) at 5 × 5 × 4 mm size. After the preparation of samples, an extraction solution was mixed with %75/%25 ethanol/water. The samples were stored in the amber-colored bottles during three different immersed periods as 1 h, 24 h, and 90 days (n = 5). After immersion, 0.5 ml solutions were taken from each bottle and analyzed using HPLC.

RESULTS

A total of 16.7 μg/ml of monomers from SB, 13.4 μg/ml of monomers from GR, 13.2 μg/ml of monomers from CS, and 6.7 μg/ml of monomers from LU were found after 3-m immersion. TEGDMA after 3-m of immersion was only released from the SB group, and also BisEMA was released from the CS group. Among the specimens immersed for 1 h, UDMA was released the least from the LU group and the most from the GR group (p < 0.05). Correspondingly, 24 h and 3 m after immersion, the highest release of monomers was found in the GR (p < 0.05).

CONCLUSIONS

When the monomer release from RCBs was evaluated, it was shown that these materials released methacrylate-based monomers except VE, especially if they were kept in a solvent solution for a long time such as 3 m.

CLINICAL SIGNIFICANCE

The novel resin-based CAD/CAM blocks might monomer release, which may cause cytotoxic effects. But, the detected amount of monomer release is below the estimated daily limit.

Influence of Material and Surface Roughness of Resin Composite Cements on Fibroblast Behavior

Clinical Relevance

A well-polished cement surface increases the viability and spreading of gingival fibroblasts. The tested resin composite cements did not reveal any cytotoxic effects.

SUMMARY

Objective: This in vitro study aimed to investigate the effect of cement type and roughness on the viability and cell morphology of human gingival fibroblasts (HGF-1).

Methods and Materials: Discs of three adhesive (Panavia V5 [PV5], Multilink Automix [MLA], RelyX Ultimate [RUL] and three self-adhesive (Panavia SA plus [PSA], SpeedCem plus [SCP], RelyX Unicem [RUN]) resin composite cements were prepared with three different roughnesses using silica paper grit P180, P400, or P2500. The cement specimens were characterized by surface roughness and energy-dispersive X-ray spectroscopic mapping. A viability assay was performed after 24 hours of incubation of HGF-1 cells on cement specimens. Cell morphology was examined with scanning electron microscopy.

Results: The roughness of the specimens did not differ significantly among the different resin composite cements. Mean Ra values for the three surface treatments were 1.62 ± 0.34 μm for P180, 0.79 ± 0.20 μm for P400, and 0.17 ± 0.08 μm for P2500. HGF-1 viability was significantly influenced by the cement material and the specimens’ roughness, with the highest viability for PSA ≥ RUN = MLA ≥ SCP = PV5 &gt; RUL (p&lt;0.05) and for P2500 = P400 &gt; P180 (p&lt;0.001). Cell morphology did not vary among the materials but was affected by the surface roughness.

Conclusion: The composition of resin composite cements significantly affects the cell viability of HGF-1. Smooth resin composite cement surfaces with an Ra of 0.2–0.8 μm accelerate flat cell spreading and formation of filopodia.

The effect of elapsed time following alumina blasting on adhesion of CAD/CAM resin block to dentin

The aim of this study was to evaluate the time elapsed bond strength of the CAD/CAM resin block (CRB) to bovine dentin after alumina blasting. CRB (KATANA AVENCIA BLOCK) slices were ground with #600-SiC paper and divided into three groups according to alumina blasting pressure -0.1 MPa, 0.2 MPa or untreated- and then divided into two subgroups according to the time elapsed after alumina blasting -same-day or one-week "dry-storage" at controlled laboratory conditions before cementation. The CRB slices were then cemented to bovine dentin with Panavia V5 (Kuraray Noritake Dental), and divided into two subgroups -light curing or chemical curing. After 24 h storage in distilled water at 37°C, the specimens were then subjected to micro-tensile bond strength (µTBS) testing. One-week group showed a significant decrease in µTBS. The µTBS values showed that CRBs must be cemented with light curing immediately after alumina blasting at 0.1 or 0.2 MPa to obtain a stable adhesion.

Viscoelastic stability of pre-cured resin-composite CAD/CAM structures

OBJECTIVES

To study the effect of water storage (3 months) on the creep deformation and recovery of CAD/CAM composite materials to determine their viscoelastic stability.

MATERIALS AND METHODS

Five CAD/CAM composite blocks, with increasing filler loading, and one polymer-infiltrated ceramic network (PICN) were studied. Six specimens of each material were separated into two groups (n=3) according to their storage conditions (24 h dry storage at 23°C versus 3 months storage in 37°C distilled water). A constant static compressive stress of 20 MPa was applied on each specimen via a loading pin for 2 h followed by unloading and monitoring strain recovery for a further period of 2 h. The maximum creep-strain (%) and permanent set (%) were recorded. Data were analysed via two-way ANOVA followed by one-way ANOVA and Bonferroni post hoc tests (<0.05) for comparisons between the materials. Homogeneity of variance was calculated via Levene's statistics.

RESULTS

The maximum creep strain after 24 h dry ranged from 0.45% to 1.09% and increased after 3-month storage in distilled water to between 0.71% and 1.85%. The permanent set after 24 h dry storage ranged from 0.033% to 0.15% and increased after 3-month water storage to between 0.087% and 0.18%. The maximum creep strain also reduced with increasing filler loading.

SIGNIFICANCE

The PICN material exhibited superior dimensional stability to all of the pre-cured resin composite blocks in both storage conditions with deformation being predominantly elastic rather than viscoelastic. Notwithstanding, two of the resin-matrix composite blocks approached the PICN performance, when dry, but less so after water storage.

Leaching behaviors of computer-aided design/computer-aided manufacturing composite resin component elements immersed in water

PURPOSE

Immersion tests in purified water were conducted to evaluate the leaching behaviors of filler elements contained in computer-aided design/computer-aided manufacturing (CAD/CAM) composite resin.

METHODS

Four commercial CAD/CAM resin composite blanks were tested: Shofu block HC 2 layer, Cerasmart, Katana Avencia block, and KZR-CAD HR Block 2. The specimens in the size of 10.0×12.0×2.0mm were immersed in a 50-mL conical tube containing 40mL of purified water, and then placed in a constant-temperature oven set at a temperature of 37, 60, 70, or 80°C and stored statically for 30 days. After storage, the concentrations of leached elements in the immersion solution were measured with an inductively coupled plasma atomic emission spectrometer. To characterize the surface of the specimen after the immersion test, secondary electron images were obtained.

RESULTS

The immersion test resulted in the leaching of Si, the main component, from all materials tested. Some materials were found to have leached high amount of Ba or Sr in addition to Si, and remarkable surface degradation was observed. The amount of leached elements increased with increased immersion temperatures.

CONCLUSIONS

Filler elements in CAD/CAM composite resins used in this study leached into purified water. The leached elements and its quantities greatly differed among materials and depend on the types of the oxides composing the filler. The amounts of leached elements varied in a temperature-dependent manner.

Effect of the Composition of CAD/CAM Composite Blocks on Mechanical Properties

The aim of this study was to evaluate the effect of the composition of CAD/CAM blocks on their mechanical properties. Nine different CAD/CAM blocks, enamel and dentine, were tested. Sixteen samples of each material were separated for Vickers microhardness test (n=6, 5 readings per specimen), nanohardness test (n=6, 5 readings per specimen), filler weight (n=3), and SEM imaging (n=1). Data were statistically analysed using one-way ANOVA. Vita Mark II ceramic showed significantly higher values of hardness (in both nano- and microscale) and elastic modulus (6.83 GPa, 502 kg/mm², and 47.7 GPa), respectively, than other materials. CAD/CAM composite blocks showed comparable values of hardness and elastic modulus to those of dentine but lower than those of enamel and ceramics. SEM images highlighted different filler-matrix microstructure of CAD/CAM composite blocks. It was concluded that (1) hardness and elastic moduli are positively correlated with ceramic filler percentage and microstructure and (2) CAD/CAM composite materials have comparable hardness and elastic moduli to tooth structure.

In Vitro Analysis of the Cytotoxicity of Indirect Restorative Materials

Abstract This study aimed to compare the cytotoxicity of the Vita AC12, Lava Ultimate, Vita Enamic and InSync indirect restorative materials. Extracts of each material were prepared by incubation for 1, 7 and 40 days, with daily washing. Human gingival fibroblasts were exposed to the extracts, and cell viability was evaluated by sequential assessment of mitochondrial activity (XTT), membrane integrity (NRU) and cell density (CVDE). Extracts of polystyrene beads and latex fragments were used as negative and positive controls, respectively. Differences between groups and experimental times were evaluated by analysis of variance. At the 24 h extraction, significant differences between the control and both Vita AC-12 and InSync were observed in the XTT assay (p<0.05), and between the control and both Enamic and Lava Ultimate, in the CVDE assay (p<0.05). AC12, Lava Ultimate, and InSync presented significantly lower cell viability than Enamic and the control group, in the NRU assay (p<0.05). The Vita Enamic and Lava Ultimate hybrid ceramic-like materials presented better biocompatibility at the 24 h extraction time point than the AC12 and InSync ceramic materials. However, a simulation of the removal of toxic components by biological fluids, conducted by using longer extraction times and daily washing, led to the absence of cytotoxicity in all the tested restorative materials. These findings can be viewed as positive for the clinical indication of these restorative materials, considering their contact with adjacent soft tissues for extended periods of time.

Biocompatibility of polymer-infiltrated-ceramic-network (PICN) materials with Human Gingival Keratinocytes (HGKs)

OBJECTIVE

Biocompatibility of polymer-infiltrated-ceramic-network (PICN) materials, a new class of CAD-CAM composites, is poorly explored in the literature, in particular, no data are available regarding Human Gingival Keratinocytes (HGK). The first objective of this study was to evaluate the in vitro biocompatibility of PICNs with HGKs in comparison with other materials typically used for implant prostheses. The second objective was to correlate results with PICN monomer release and indirect cytotoxicity.

METHODS

HGK attachment, proliferation and spreading on PICN, grade V titanium (Ti), yttrium zirconia (Zi), lithium disilicate glass-ceramic (eM) and polytetrafluoroethylene (negative control) discs were evaluated using a specific insert-based culture system. For PICN and eM samples, monomer release in the culture medium was quantified by high performance liquid chromatography and indirect cytotoxicity tests were performed.

RESULTS

Ti and Zi exhibited the best results regarding HGK viability, number and coverage. eM showed inferior results while PICN showed statistically similar results to eM but also to Ti regarding cell number and to Ti and Zi regarding cell viability. No monomer release from PICN discs was found, nor indirect cytotoxicity, as for eM.

SIGNIFICANCE

The results confirmed the excellent behavior of Ti and Zi with gingival cells. Even if polymer based, PICN materials exhibited intermediate results between Ti-Zi and eM. These promising results could notably be explained by PICN high temperature-high pressure (HT-HP) innovative polymerization mode, as confirmed by the absence of monomer release and indirect cytotoxicity.

Biocompatibility of polymer-infiltrated-ceramic-network (PICN) materials with Human Gingival Fibroblasts (HGFs)

OBJECTIVES

Polymer-infiltrated-ceramic-network (PICN) materials constitute an innovative class of CAD-CAM materials offering promising perspectives in prosthodontics, but no data are available in the literature regarding their biological properties. The objective of the present study was to evaluate the in vitro biocompatibility of PICNs with human gingival fibroblasts (HGFs) in comparison with materials typically used for implant prostheses and abutments.

METHODS

HGF attachment, proliferation and spreading on discs made of PICN, grade V titanium (Ti), yttrium zirconia (Zi), lithium disilicate glass-ceramic (eM) and polytetrafluoroethylene (negative control), were evaluated using a specific insert-based culture system (IBS-R). Sample surface properties were characterized by XPS, contact angle measurement, profilometry and SEM.

RESULTS

Ti and Zi gave the best results regarding HGF viability, morphology, number and coverage increase with time in comparison with the negative control, while PICN and eM gave intermediate results, cell spreading being comparable for PICN, Ti, Zi and eM. Despite the presence of polymers and their related hydrophobicity, PICN exhibited comparable results to glass-ceramic materials, which could be explained by the mode of polymerization of the monomers.

SIGNIFICANCE

The results of the present study confirm that the currently employed materials, i.e. Ti and Zi, can be considered to be the gold standard of materials in terms of HGF behavior, while PICN gave intermediate results comparable to eM. The impact of the present in vitro results needs to be further investigated clinically, particularly in the view of the utilization of PICNs for prostheses on bone-level implants.

From Artisanal to CAD-CAM Blocks

Indirect composites have been undergoing an impressive evolution over the last few years. Specifically, recent developments in computer-aided design–computer-aided manufacturing (CAD-CAM) blocks have been associated with new polymerization modes, innovative microstructures, and different compositions. All these recent breakthroughs have introduced important gaps among the properties of the different materials. This critical state-of-the-art review analyzes the strengths and weaknesses of the different varieties of CAD-CAM composite materials, especially as compared with direct and artisanal indirect composites. Indeed, new polymerization modes used for CAD-CAM blocks—especially high temperature (HT) and, most of all, high temperature–high pressure (HT-HP)—are shown to significantly increase the degree of conversion in comparison with light-cured composites. Industrial processes also allow for the augmentation of the filler content and for the realization of more homogeneous structures with fewer flaws. In addition, due to their increased degree of conversion and their different monomer composition, some CAD-CAM blocks are more advantageous in terms of toxicity and monomer release. Finally, materials with a polymer-infiltrated ceramic network (PICN) microstructure exhibit higher flexural strength and a more favorable elasticity modulus than materials with a dispersed filler microstructure. Consequently, some high-performance composite CAD-CAM blocks—particularly experimental PICNs—can now rival glass-ceramics, such as lithium-disilicate glass-ceramics, for use as bonded partial restorations and crowns on natural teeth and implants. Being able to be manufactured in very low thicknesses, they offer the possibility of developing innovative minimally invasive treatment strategies, such as “no prep” treatment of worn dentition. Current issues are related to the study of bonding and wear properties of the different varieties of CAD-CAM composites. There is also a crucial need to conduct clinical studies. Last, manufacturers should provide more complete information regarding their product polymerization process, microstructure, and composition, which significantly influence CAD-CAM material properties.

Infrared spectroscopy, nano-mechanical properties, and scratch resistance of esthetic orthodontic coated archwires

OBJECTIVE

To evaluate the material composition, mechanical properties (hardness and elastic modulus), and scratch resistance of the coating of four commercialized esthetic orthodontic archwires.

MATERIALS AND METHODS

The coating composition of esthetic archwires was assessed by Fourier-transform infrared spectroscopy (FTIR). Coating hardness and elastic modulus were analyzed with instrumented nano-indentation tests. Scratch resistance of coatings was evaluated by scratch test. Coating micromorphologic characteristics after scratch tests were observed in a scanning electron microscope. Statistical differences were investigated using analysis of variance and Tukey post hoc test.

RESULTS

The FTIR results indicate that all analyzed coatings were markedly characterized by the benzene peak at about 1500 cm(-1). The coating hardness and elastic modulus average values ranged from 0.17 to 0.23 GPa and from 5.0 to 7.6 GPa, respectively. Scratch test showed a high coating elasticity after load removal with elastic recoveries >60%, but different failure features could be observed along the scratches.

CONCLUSION

The coatings of esthetic archwires evaluated are probably a composite of polyester and polytetrafluoroethylene. Delamination, crack propagation, and debris generation could be observed along the coating scratches and could influence its durability in the oral environment.

Effect of temperature on the mass and color stability of additional photoinitiatorcontaining composite resins

The purpose of this study was to evaluate how the temperature affects the stability of polymerized additional photoinitiator-containing composite resins. Five resin products were light-cured using a quartz-tungsten-halogen, and single and dual emission peaks lightemitting diodes. The degree of conversion (DC) and water sorption, solubility, and color change of the specimens were evaluated after immersion in the solutions of different temperatures (4, 37, and 60ºC) for 14 days. On the top surface, the light-curing units had no significant influence on DC of the tested specimens. On the bottom surface, the influence was inconsistent. As the solution temperature increased, water sorption also consistently increased in all specimens, whereas solubility changed inconsistently. Water sorption and solubility had a high linear correlation only at low temperature solution. Color change of the specimens was similar, mostly slight, and statistically inconsistent regardless of solution temperature. The restored composite resins are needed to avoid contact with hot solutions for durable dental restoration.

Influence of a blue DPSS laser on specimen thickness of composite resins

OBJECTIVE

The purpose of the present study was to investigate the effect of 473 nm diode-pumped solid state (DPSS) laser on the curing depth of composite resins.

BACKGROUND DATA

Within the turbid media, light attenuates significantly because of the absorption and scattering.

MATERIALS AND METHODS

For the study, three different composite resins and light-curing units (LCUs) (a quartz-tungsten-halogen [QTH], light-emitting-diode [LED], and DPSS laser) were used. The number of photons transmitted through the specimens, degree of conversion (DC), microhardness, and refractive index of the specimens on different thicknesses were evaluated.

RESULTS

The incident light exponentially decreased within the specimens. Among the LCUs, QTH showed the least photon loss. The DC obtained using the DPSS laser and QTH was significantly greater (p<0.001) than that obtained using LED. The specimens light cured using the DPSS laser showed slightly lower microhardness than that cured by the other LCUs. On each depth, the mean refractive index was not significantly different for the LCUs used. DC, microhardness, and refractive index had inverse linear correlation with specimen thickness despite exponential decrease of photons number. On the other hand, DC, microhardness, and refractive index were linearly correlated to each other regardless of LCUs.

CONCLUSIONS

The DPSS laser of 473 nm achieved a similar level of polymerization within the specimens as those of the other LCUs even with much lower light intensity. This laser can be applied as a light source for light curing of composite resins.

Effect of precuring warming on mechanical properties of restorative composites

To investigate the effect of prepolymerization warming on composites' mechanical properties, three composites were evaluated: Clearfil Majesty (CM) (Kuraray), Z-100 (3M/ESPE), and Light-Core (LC) (Bisco). Specimens were prepared from each composite at room temperature as control and 2 higher temperatures (37°C and 54°C) to test surface hardness (SH), compressive strength (CS), and diametral tensile strength (DTS). Data were statistically analyzed using ANOVA and Fisher's LSD tests. Results revealed that prewarming CM and Z100 specimens significantly improved their SH mean values (P < 0.05). Prewarming also improved mean CS values of Z100 specimens (P < 0.05). Furthermore, DTS mean value of CM prepared at 52° was significantly higher than that of room temperature specimens (P < 0.05). KHN, CS, and DTS mean values varied significantly among the three composites. In conclusion, Prewarming significantly enhanced surface hardness of 2 composites. Prewarming also improved bulk properties of the composites; however, this improvement was significant in only some of the tested materials.

Recent advances and developments in composite dental restorative materials

Composite dental restorations represent a unique class of biomaterials with severe restrictions on biocompatibility, curing behavior, esthetics, and ultimate material properties. These materials are presently limited by shrinkage and polymerization-induced shrinkage stress, limited toughness, the presence of unreacted monomer that remains following the polymerization, and several other factors. Fortunately, these materials have been the focus of a great deal of research in recent years with the goal of improving restoration performance by changing the initiation system, monomers, and fillers and their coupling agents, and by developing novel polymerization strategies. Here, we review the general characteristics of the polymerization reaction and recent approaches that have been taken to improve composite restorative performance.

In situ formation of silver nanoparticles in photocrosslinking polymers

Nanocomposites of cross-linked methacrylate polymers with silver nanoparticles have been synthesized by coupling photoinitiated free radical polymerization of dimethacrylates with in situ silver ion reduction. A polymerizable methacrylate bearing a secondary amino functional group was used to increase the solubility of the silver salt in the hydrophobic resin system. Fourier transform infrared spectroscopy (FTIR) revealed that the silver ion reduction had no significant effect on the degree of vinyl conversion of the methacrylate. X-ray photoelectron spectroscopy (XPS) measurements showed an increased silver concentration at the composite surface compared to the expected concentration based on the total amount of silver salt added. Furthermore, the surface silver concentration leveled off when the silver salt mass fractions were 0.08% or greater. Composites with low concentrations of silver salt (< 0.08% by mass) exhibited comparable mechanical properties to those containing no silver. Transmission electron microscopy (TEM) confirmed that the silver nanoparticles formed within the polymer matrix were nanocrystalline in nature and primarily ≈ 3 nm in diameter, with some large particle aggregates. Composites containing silver nanoparticles were shown to reduce bacterial colonization with as little as 0.03% (by mass) silver salt, while additional amounts of silver salt did not further decrease their surface colonization. With a substantial effect on bacterial growth and minimal effects on mechanical properties, the in situ formation of silver nanoparticles within methacrylate materials is a promising technique for synthesizing antibacterial nanocomposites for biomedical applications.

Combinatorial and high-throughput screening of biomaterials

Combinatorial and high-throughput methods have been increasingly used to accelerate research and development of new biomaterials. These methods involve creating miniaturized libraries that contain many specimens in one sample in the form of gradients or arrays, followed by automated data collection and analysis. This article reviews recent advances in utilizing combinatorial and high-throughput methods to better understand cell-material interactions, particularly highlighting our efforts at the NIST Polymers Division. Specifically, fabrication techniques to generate controlled surfaces (2D) and 3D cell environments (tissue engineering scaffolds) as well as methods to characterize and analyze material properties and cell-material interactions are described. In conclusion, additional opportunities for combinatorial methods for biomaterials research are noted, including streamlined sample fabrication and characterization, appropriate and automated bioassays, and data analysis.

Thiol-ene-methacrylate composites as dental restorative materials

OBJECTIVES

The objective of this study was to evaluate composite methacrylate-thiol-ene formulations with varying thiol:ene stoichiometry relative to composite dimethacrylate control formulations. It was hypothesized that the methacrylate-thiol-ene systems would exhibit superior properties relative to the dimethacrylate control resins and that excess thiol relative to ene would further enhance shrinkage and conversion associated properties.

METHODS

Polymerization kinetics and functional group conversions were determined by Fourier transform infrared spectroscopy (FTIR). Volume shrinkage was measured with a linometer and shrinkage stress was measured with a tensometer. Flexural modulus and strength, depth of cure, water sorption and solubility tests were all performed according to ISO 4049.

RESULTS

All of the methacrylate-thiol-ene systems exhibited improvements in methacrylate conversion, flexural strength, shrinkage stress, depth of cure, and water solubility, while maintaining equivalent flexural modulus and water sorption relative to the dimethacrylate control systems. Increasing the thiol to ene stoichiometry resulted in further increased methacrylate functional group conversion and decreased volume shrinkage. Flexural modulus and strength, shrinkage stress, depth of cure, water sorption and solubility did not exhibit statistically significant changes with excess thiol.

SIGNIFICANCE

Due to their improved overall functional group conversion and reduced water sorption, the methacrylate-thiol-ene formulations are expected to exhibit improved biocompatibility relative to the dimethacrylate control systems. Improvements in flexural strength and reduced shrinkage stress may be expected to result in composite restorations with superior longevity and performance.