Influence of photoinitiator type on the rate of polymerization, degree of conversion, hardness and yellowing of dental resin composites

Characterization of 3D printed composite for final dental restorations

OBJECTIVES

This study evaluated the mechanical, optical, microstructural, surface, and adhesive behavior of a 3D printing resin comparing it with a machinable resin composite.

MATERIALS AND METHODS

Specimens of different sizes and shapes were either printed (Vitality, Smart Dent) or machinable (Grandio Blocs, Voco GmbH) resin composites with similar composition were prepared. Surface and mechanical characterization were performed with Knoop hardness, flexural strength (three-point-bending), and elastic modulus tests. The wear of the tested materials was evaluated against steatite antagonists. The optical properties stability (color change, ΔE00, and translucency, TP00) were observed after staining in red wine. In addition, the bond strength of the resin composites to two resin cement protocols were investigated with microshear bond strength tests at baseline and after thermocycling. Scanning electron microscope (SEM) coupled with Energy-Dispersive X-ray Spectroscopy (EDS) was used for microstructural and chemical characterization. Statistical analyses were performed with t- and ANOVA tests.

RESULTS

Hardness values (132.76 (16.32) KH- Machinable and 35.87 (2.78) KH - Printed), flexural strength (172.17 (26.99) MPa - Machinable and 88.69 (8.39) MPa - Printed), color and translucency change (1.86 (0.31)/0.06 - Machinable and 3.73 (0.36)/9,16- Printed), and wear depth (24.97 mm (3.60)- Machinable and 7.16 mm (2.84) - Printed) were statistically different. Average Regarding bond strength, mean values (MPa) for non-aged and aged groups were respectively 21.76 (6.64) / 31.9 (12.66) for Bifix cement (Voco GmbH, Cuxhaven, Germany) and 26.75 (5.14) / 24.36 (6.85) for Variolink cement (Ivoclar Vivadent, Schaan, Liechtenstein) in Printed and 17.79 (3.89) / 9.01 (3.36) ) for Bifix cement and 22.09 (6.55) / 11.01 (3.77) for Variolink cement in Machinable materials. The material and aging factors did affect bond strength but the cement factor did not (p = 0.202). No statistical differences were observed for mean roughness (Ra) between materials. The better dispersion and larger size of the inorganic particles in the Machinable resin were contrasted with the clustered smaller particles of printed resin, under SEM.

CONCLUSIONS

The mechanical properties and color stability of the machinable resin were superior to those of the printed resin, probably due to the greater amount and dispersion of inorganic particles in the Mach resin, but bond strength after aging was stronger and more stable in the printed resin.

CLINICAL RELEVANCE

3D-printed resin composites with similar compositions to machinable resin composites do not necessarily exhibit the same properties, which can impact clinical performance. Understanding these differences can assist manufacturers in improving their materials and help clinicians distinguish between materials appropriate for provisional and final restorations.

Evaluation of pulp chamber temperature during cementation with the preheated composite resin technique

STATEMENT OF PROBLEM

The cementation technique using preheated composite resin requires high temperatures for optimal execution and may lead to increased and damaging intrapulpal temperatures. Whether the technique can lead to a temperature increase that might lead to necrosis of the pulp tissue is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the temperature variation in the pulp chamber of bovine teeth with veneer-type preparations during veneer cementation using the preheated composite resin technique.

MATERIAL AND METHODS

A total of 103 bovine incisors were divided into 8 groups (n=10) and prepared for indirect veneers with different preparation depths: 2.0 mm, 1.5 mm, 1.0 mm, and 0.5 mm. Veneers were cemented on these preparations using 2 cementation protocols: preheated composite resin and photopolymerizable resin cement. The teeth were attached to a device containing a temperature sensor which was inserted into the pulp chamber to quantify the intrapulpal temperature variation produced during the cementation protocols. The data were analyzed using a statistical software program. The level of statistical significance for the analyses was with a confidence interval of 95%, sampling power of 80%, and a moderate effect size (0.36).

RESULTS

The groups cemented with preheated composite resin and the groups with the greatest preparation depth had the highest mean intrapulpal temperature; the PHC2 group presented a mean ±standard deviation temperature increase of 5.70 ±2.14 °C.

CONCLUSIONS

The heat generated by heating the resin contributed to the increase in intrapulpal temperature. Temperature variations were greater in deeper preparations, especially when preheated resin technique was used.

The effect of photoinitiator type and filler load on physicochemical and mechanical properties of experimental light-cured resin cements through lithium disilicate ceramics of different shades and thicknesses

OBJECTIVE

This study investigated the influence of photoinitiator types on degree of conversion (DC), rate of polymerization (RP), flexural strength (FS), flexural modulus (FM), and light transmittance (LT) of filled and unfilled light-curable resin cements through different thicknesses and shades of lithium disilicate ceramics.

METHODS

Lithium disilicate ceramic discs (IPS Emax Press, background [0.0], 0.5, 1.0, 2.0, 3.0, and 4.0 mm, shades A1 and BL3) were prepared. Experimental resin-based cements [TEGDMA/BisGMA (50/50 mass%)] were prepared using either camphorquinone (CQ)/amine (0.44/1.85 mol%) or TPO (0.44 mol%)], and a micro and nanofiller loads of nil (unfilled); 40/10 mass%; and 50/10 mass%). Resin cements (0.2 mm thick) were placed on the lower surface of the ceramic specimens and light-activated for 30 s from the upper surface using a Bluephase Style curing light (exitance at tip: 1236 mW/cm2 ± 1.20). LT and distribution of irradiance through the ceramics were measured using a UV-vis spectrometer and a beam profile camera, respectively (n = 3). The DC and RP were measured in real-time using mid infrared spectroscopy in attenuated total reflectance (ATR) mode (n = 3). FS and FM were measured using a universal testing machine (n = 5). Statistical analyses were performed on LT, DC, RP, FS, and FM data using a general linear model, and supplementary ANOVA and post hoc Tukey multiple comparison test were also performed (α = .05).

RESULTS

Thicknesses, shades, photoinitiator type, and fillers load significantly influenced the optical and mechanical characteristics of the resin-based materials (p < 0.05). The BL3 shade ceramic provided higher values of DC, RP, FS, FM, and LT compared with the A1 shade (p < 0.05). Increasing ceramic thickness decreased the properties of the resin-based materials (p < 0.05). Generally, TPO improved mechanical properties of the resin cement compared with CQ (p < 0.05).

SIGNIFICANCE

The luting process of indirect restorations may be improved by using high molar absorptivity, more reactive, and more efficient photoinitiators such as TPO, as opposed to conventional CQ. The use of such initiator may allow the placement of thicker and more opaque indirect restorations.

Color-Stable Formulations for 3D-Photoprintable Dental Materials

Color stability is crucial for dental materials to ensure they perfectly match a patient's tooth color. This is particularly challenging in photoresist-based additive manufacturing. Although some studies have addressed this issue, the exact causes of discoloration and ways to minimize it remain unclear. In this study, the intrinsic causes of discoloration in materials intended for 3D printing are investigated by examining thin-film samples (1200 µm) of various compositions, which are stored under different conditions. The samples are evaluated by measuring the UV-Vis absorption spectra at regular intervals to monitor changes. The findings reveal that both the composition of the formulations and the storage conditions significantly influence the discoloration behavior. Furthermore, methods have been developed to reduce or completely prevent discoloration. The use of photoinitiators with sterically demanding benzoyl moieties, as well as the addition of stabilizers, effectively decreases the intensity of emerging discoloration. Furthermore, incorporating the oxidizing agent cumene hydroperoxide (CHP) results in materials that maintain color stability.

Flexural strength and degree of conversion of universal single shade resin-based composites

Background/purpose

Recently, a group of universal single-shade resin-based composites (RBCs) has been developed to simplify the process of shade selection. Excellent mechanical and physical properties are crucial for the ultimate success and clinical longevity of restorations. Therefore, evaluating the properties of the single-shaded RBCs is imperative. This study aimed to determine the flexural strength (FS) and degree of conversion (DC) of universal single-shade RBCs.

Materials and methods

In this study, four commercial RBCs were used; three universal single-shade RBCs; Omnichroma (OC), Charisma® Diamond ONE (CD), and Vittra APS Unique (VU), and a conventional nanohybrid composite Filtek™ Z250 XT (FT) which was used as a control. Sixty composite beams and 40 composite discs were used for FS and DC, respectively. A universal test machine with a three-point bending test was used to measure the FS, whereas the DC was measured using a Fourier-transform infrared spectrometer (FTIR). Three fractured specimens from each resin composite group were qualitatively analyzed using scanning electron microscopy.

Results

ANOVA was used to compare the mean values of FS and DC among the four RBCs (OC, CD, VU, and FT). Highly significant differences were observed in the mean FS and DC values (F = 673.043, p < 0.001 and F (=782.4, p < 0.0001), respectively. The highest FS was observed in the CD group, followed by FT and VU groups; the lowest value was observed in the OC group. In addition, a statistically significant difference was identified in DC values. The highest DC value was observed in VU, followed by OC and CD, and the lowest DC value was observed in FT.

Conclusion

Universal single-shade RBCs demonstrated a good FS, except for OC, which exhibited a significantly low FS. The DC of the universal single-shade RBCs was higher than that of the conventional nanohybrid composite restorative material.

Comparison of Blue and Infrared Light Transmission Through Dental Tissues and Restorative Materials

OBJECTIVES

The depth of cure using blue-light photocuring units (BL) is limited by tooth structure and qualities of the restorative material through which the activating wavelength must pass. Recent developments incorporate an infrared (IR) activated upconversion (UC) fluorescence of a lining agent filled with nanocrystals of NaYF4 and doped with YB+3 and Tm+3 that emit both blue and violet light locally at the interface of the liner and restorative resin. The purpose of this study was to evaluate the BL and 975 nm infrared (IR) light power transmission through dental tissues and restorative materials.

METHODS AND MATERIALS

Power transmissions of the IR laser (975 nm) and a monowave blue-only light-curing unit (Bluephase 16i) through dental tissues (enamel, dentin, and enamel/dentin junction, or DEJ), eight (8) various dental resin composites, and eight (8) dental ceramics, each at four thicknesses (1, 2, 3 and 4 mm) were evaluated (n=5) using a thermopile sensor (PM10, Coherent Inc) connected to a laser power meter (Fieldmate, Coherent Inc). Power transmission values of each light source and restorative material were subjected to analysis of variance and Tukey test at a pre-set alpha of 0.05.

RESULTS

A linear correlation (r=0.9884) between the supplied current and emitted IR power of the laser diode was found, showing no statistical power reduction with increased distances (collimated beam). For tooth tissues, the highest power transmissions for both light sources were observed using 1.0 mm enamel while the lowest values were found for 2.0 mm dentin and an association of 2.0 mm DEJ and 1.0 mm dentin. The only group where IR demonstrated significantly higher transmission when compared to BL was 1.0 mm enamel. For all resin composites and dental ceramics, increased thickness resulted in a reduction of IR power transmission (except for EverX Posterior fiber-reinforced composite and e.max HT ceramic). IR resulted in higher transmission through all resin composites, except for Tetric EvoCeram White. The highest BL transmission was observed for SDR Flow, at all thicknesses. Higher IR/BL ratios were observed for EverX Posterior, Herculite Ultra, and Lava Ultimate, while the lowest ratio was observed for Tetric EvoCeram White. Reduced translucency shades within the same material resulted in lower power ratio values, especially for BL transmission. Higher IR/BL ratios were observed for e.Max LT, VitaVM7 Base Dentin, and e.max CAD HT, while the lowest values were found for VitaVM7 Enamel and Paradigm C.

CONCLUSION

IR power transmission through enamel was higher when compared to blue light, while no difference was observed for dentin. The power transmission of IR was higher than BL for resin composites, except for a high value and low chroma shade. Fiber-reinforced resin composite demonstrated the highest IR/BL power transmission ratio. A greater IR/BL ratio was observed for lower translucency ceramics when compared to high translucency.

Effects of various beverages on characteristics of provisional restoration materials

OBJECTIVE

To investigate the effect of common beverages on four currently used provisional restoration materials: Protemp®4, Integrity®, polymethyl methacrylate (PMMA) block, and acrylic resin. Flowable resin composite is included as a control group.

MATERIALS AND METHODS

Each material was formed into disks of 10-mm diameter and 4-mm thickness (N = 40) by loading the material into acrylic molds. The exposed surface in the mold was covered using a glass slide to prevent an oxygen inhibition layer, and polymerization then proceeded. The solidified disks were placed in distilled water for 24 h. These samples (n = 8) were then immersed for 14 days in one of four different beverages: water, orange juice, cola, and coffee. Changes in color dimension, hardness, and roughness were observed and then analyzed using two-way repeated analysis of variance.

RESULTS

The provisional materials had more obvious changes in all three color dimensions than the flowable resin composite. Integrity showed the biggest changes, followed by acrylic resin and PMMA block, whereas Protemp had the smallest changes. The hardness of all the materials significantly decreased after immersion in any of the beverages for 14 days. There were no changes in surface roughness when the materials were immersed in distilled water. The surface roughness of the PMMA block significantly decreased in orange juice whereas that of Integrity and acrylic resin significantly increased in cola.

CONCLUSION

Different kinds of provisional materials had different degrees of staining due to their composition. Moisture had a significant influence on the hardness of materials, and the acidity of cola significantly roughened the surface of the provisional materials.

Analysis of color stability and degree of conversion of different types of resin composites

Resin composites containing surface pre-reacted glass (S-PRG) have been introduced to reduce demineralization and improve remineralization of the tooth structure. However, water diffusion within the material is necessary for its action, which can impair its overall physicomechanical properties over time, including color stability. This study aimed to evaluate the color stability and related degree of conversion (DC) of four resin composites. Discs (6 x 4 mm, n = 5/group) of microhybrid (MH), nanofilled (NF), nanohybrid (NH), and S-PRG-based nanohybrid (S-PRG-NH) composites with two opacities (A2/A2E and A2O/A2D) were prepared. Color (CIELab and CIEDE2000) was evaluated with a spectrophotometer after aging in grape juice (2 x 10 min/10mL/7days). The DC was analyzed by using Fourier transform infrared spectroscopy before and after light-curing. Data were statistically analyzed by using two-way analysis of variance and post-hoc least significant difference tests (p<0.05). In the color stability analysis, the interaction between filler type and opacity was significant (CIELab, p = 0.0015; CIEDE2000, p = 0.0026). NH presented the highest color stability, which did not differ from that of MH. The greatest color alteration was observed for S-PRG-NH. S-PRG fillers also influenced DC (p < 0.05). The nanohybrid resin composite presented favorable overall performance, which is likely related to its more stable organic content. Notwithstanding the benefits of using S-PRG-based nanohybrid resins, mostly in aesthetic procedures, professionals should consider the susceptibility of such resins to color alteration, probably due to the water-based bioactive mechanism of action.

Multi-peak Light-emitting Diode Curing Units and Polymerization of 3D-printed Crown and Bridge Resin

PURPOSE

This study aimed to evaluate the substitutive and additive efficacy of multi-peak light-emitting diode (LED) curing units for post-curing of a three-dimensional- (3D-) printed crown and bridge resin.

METHODS

A total of 792 disc- and 180 bar-shaped specimens were printed with a crown and bridge resin (NextDent C&B MFH) and post-cured using two LED curing units (VALO Cordless and Bluephase N G4) in fast and standard modes. Conventional post-curing (LC-3D Print Box, Group PC) was compared with LED-only curing (Groups V1, V2, B1, and B2) and LED-combined curing (Groups PV1, PV2, PB1, and PB2) in terms of microhardness, flexural strength, degree of conversion (DC), and CIE L*a*b* color and translucency parameters. Cytotoxicity of the resin eluates was evaluated using the WST-1 assay. Temperature increases on the resin surface were measured with infrared thermography. Data were statistically analyzed using ANOVA and Kruskal-Wallis tests (α=0.05).

RESULTS

The microhardness and flexural strength in Groups V1, V2, B1, and DC in all LED-only groups were lower than in other groups (p<0.05). Larger color disparities existed between Group PC and all LED-only groups than between Group PC and the others (p<0.05). There was no significant difference in cytotoxicity among the groups. The temperature increase was lowest in Groups V1 and PV1 during light curing (p<0.05).

CONCLUSIONS

Post-curing by multi-peak LED curing units was not as effective as the conventional post-curing device. Additional post-curing by LED curing units did not improve the material properties.

Effect of thickness and shade of CAD/CAM composite on the light transmission from different light-curing units

The thickness and shade of a restoration will affect the transmission of light from the light-curing unit (LCU). This study determined the power (mW), spectral radiant power (mW/nm), and beam profile of different LCUs through various thicknesses and shades of a CAD-CAM resin composite (BRAVA Block, FGM). Five thicknesses: 0.5; 0.75; 1.0; 1.5, and 2.0 mm, in three shades: Bleach; A2 and A3.5 of a CAD-CAM resin (n = 5). Two single-peak LCUs: EL, Elipar DeepCure-S (3M Oral Care); and OP, Optilight Max (Gnatus), and one multiple-peak LCU: VL, VALO Grand (Ultradent), were used. The LCUs were positioned touching the surface of the BRAVA Block. The power and emission spectrum were measured using a fiberoptic spectrometer attached to an integrating sphere, and the beam profiles using a laser beam profiler. The effect of the material thickness on the light attenuation coefficients was determined. VL and EL delivered more homogeneous beam profiles than OP. The type of the BRAVA Block had a significant effect on the transmitted power, and wavelengths of transmitted light (p < 0.001). There was an exponential reduction in the power and emission spectrum as the thickness of the BRAVA Block increased (p < 0.001). The light transmission through the A2 shade was least affected by the thickness (p < 0.001). The attenuation coefficient was higher for the violet light and higher for A3.5 than the A2 or Bleach shades. No violet light from the VL could be detected at the bottom of 2.0 mm of the BRAVA Block.

Are polywave light-emitting diodes more effective than monowave ones in the photoactivation of resin-based materials containing alternative photoinitiators? A systematic review

OBJECTIVE

This systematic review aimed to analyze if using polywave light-emitting diodes (LED) to photoactivate resin-based materials (resin composites, adhesive systems, and resin cements) containing alternative photoinitiators provide better physicochemical properties than monowave ones.

MATERIAL AND METHODS

Inclusion criteria were in vitro studies that evaluated the degree of conversion, microhardness and flexural strength in resin-based materials containing alternative photoinitiators and light-activated with mono and polywave LEDs. Exclusion criteria were studies that evaluated the physicochemical properties of composites through any material interposed between the LED and the resin composite and studies that exclusively compared different modes and/or light activation times. Selection of studies, data extraction, and risk-of-bias analysis was performed. Data from selected studies were qualitatively analyzed. A systematic search was performed in June 2021 using PubMed/Medline, Embase, Scopus, and ISI Web of Science databases and grey literature without language restriction.

RESULTS

A total of 18 studies were included in the qualitative analysis. Nine studies used diphenyl (2,4,6-trimethylbenzoyl) phosphine oxide (TPO) as an alternative photoinitiator for resin composite. Polywave LED improved the degree of conversion of resin composite compared to monowave in 9 of the included studies. Polywave LED improved the microhardness of resin composite compared to monowave in 7 of the included studies. Polywave LED improved the degree of conversion for 11 studies and microhardness of resin composite compared to monowave for 7 included studies. No differences in the flexural strength medium between poly and monowave LEDs were observed. The evidence was graded as low quality due to the high risk of bias for 11 studies.

CONCLUSION

The existing studies, with their limitations, revealed that the polywave light-emitting diode maximizes activation, resulting in a higher degree of double-bond conversion and microhardness of resin composites containing alternative photoinitiators. However, the flexural strength of these materials is not influenced by the type of light activation device.

Toxicity of resin-matrix cements in contact with fibroblast or mesenchymal cells

The main aim of this study was to perform an integrative review on the toxic effects of resin-matrix cements and their products in contact with fibroblasts or mesenchymal cells. A bibliographic search was performed on PubMed using the following search terms: "cytotoxicity" AND "fibroblast" OR "epithelial" OR "mesenchymal" AND "polymerization" OR "degree of conversion" OR "methacrylate" OR "monomer" AND "resin cement" OR "resin-based cement". The initial search in the available database yielded a total of 277 articles of which 21 articles were included in this review. A decrease in the viability of mouse fibroblasts ranged between 13 and 15% that was recorded for different resin-matrix cements after light curing exposure for 20 s. The viability of human fibroblasts was recorded at 83.11% after light curing for 20 s that increased up to 90.9% after light curing exposure for 40 s. Most of the studies linked the highest toxicity levels when the cells were in contact with Bis-GMA followed by UDMA, TEGDMA and HEMA. Resin-matrix cements cause a cytotoxic reaction when in contact with fibroblasts or mesenchymal cells due to the release of monomers from the polymeric matrix. The amount of monomers released from the resin matrix and their cytotoxicity depends on the polymerization parameters.

Color Stability of Resin Cements after Water Aging

The color stability of resin cements plays a key role in the achievement of esthetically-pleasant restorations. Resin luting materials can be mainly divided into two main classes: adhesive (relying on previous application of adhesive systems) or self-adhesive (also known as one-step cements). The different chemical compositions determine their physio-mechanical characteristics which, in turns, influence their color stability. To evaluate the color variations of different dual-cured resin cements after water aging, 80 disc-shaped specimens (15 mm in diameter and 1.2 mm thick) were obtained from the following resin cements (n = 10): (1) Maxcem Elite Universal, MCU (Kerr); (2) RelyX Universal, RXU (3M); (3) Calibra Ceram, CAL (Dentsply); (4) Multilink, MUL (Ivoclar-Vivadent); (5) Panavia V5, PAN (Kuraray); (6) Calibra Universal, CUN (Dentsply); (7) SpeedCEM Plus, SCP (Ivoclar); and (8) Panavia SA, PSA (Kuraray). After light-polymerization, the specimens were measured with a spectrophotometer and CIELab* values were recorded. The specimens were then placed in a digitally controlled thermostatic water bath at 60° for 30 days and afterwards the color measurements were repeated. Color differences were calculated for each specimen before and after water-aging procedures with ΔEab formula and the data were statistically analyzed (p < 0.05). The type of cement statistically influenced the ΔEab (p < 0.05), with MCU showing the lowest color variations (4.3 ± 0.7) whereas RXU and PSA the highest (16.9 ± 1.6 and 16.8 ± 1.2, respectively). No differences were observed between CAL, CUN and SCP (p = 0.05). Color stability is related to the chemical composition of the resinous luting materials, thus material dependent.

Effect of irradiance from curing units on the microhardness of composite - a systematic review

Purpose The systematic review aims to evaluate the effect of light irradiance from light-curing units on microhardness of composite.Materials and methods The protocol was registered in PROSPERO following which primary search was carried out via MedLine, Scopus and Cochrane Library. A customised tool was used to assess the risk of bias. Among the 303 records retrieved from the databases, only ten articles qualified for qualitative synthesis after meeting all the requirements of the eligibility criteria. Covidence software was used to record the decisions. The studies published until 31 March 2021 were taken up for the review. The articles showed a low-to-moderate risk of bias.Results From a total of 303 articles, ten articles were reviewed for full text. Ten in vitro studies were included for qualitative analysis. There was heterogeneity in sample size, curing time and outcome measured. Therefore, meta-analysis was not performed. Out of ten studies, seven studies reported higher microhardness value for higher intensity than lower intensity of light.Conclusion Despite the fact that the findings of the evaluated studies are quite variable, significant scientific evidence revealed that high light intensity can enhance the hardness of resin composites.

Effect of Printing Layer Thickness and Postprinting Conditions on the Flexural Strength and Hardness of a 3D-Printed Resin

Background

Recently, dentists can utilize three-dimensional printing technology in fabricating dental restoration. However, to date, there is a lack of evidence regarding the effect of printing layer thicknesses and postprinting on the mechanical properties of the 3D-printed temporary restorations with the additive manufacturing technique. So, this study evaluated the mechanical properties of a 3D-printed dental resin material with different printing layer thicknesses and postprinting methods.

Methods

210 specimens of a temporary crown material (A2 EVERES TEMPORARY, SISMA, Italy) were 3D-printed with different printing layer thicknesses (25, 50, and 100 μm). Then, specimens were 3D-printed using DLP technology (EVERES ZERO, DLP 3D printer, SISMA, Italy) which received seven different treatment conditions after printing: water storage for 24 h or 1 month, light curing or heat curing for 5 or 15 minutes, and control. Flexural properties were evaluated using a three-point bending test on a universal testing machine (ISO standard 4049). The Vickers hardness test was used to evaluate the microhardness of the material system. The degree of conversion was measured using an FT-IR ATR spectrophotometer. Statistical analysis was performed using two-way analysis of variance (ANOVA) and Tukey's honestly significant difference (HSD) test (p ≤ 0.05).

Results

The 100 μm printing layer thickness had the highest flexural strength among the other thickness groups. As a combined effect printing thickness and postprinting conditions, the 100 μm with the dry storage group has the highest flexural strength among the tested groups (94.60 MPa). Thus, the group with 100 μm thickness that was heat cured for 5 minutes (HC 5 min 100 μm) has the highest VHN value (VHN = 17.95). Also, the highest mean DC% was reported by 50 μm layer thickness (42.84%).

Conclusions

The thickness of the 100 μm printing layer had the highest flexural strength compared to the 25 μm and 50 μm groups. Also, the postprinting treatment conditions influenced the flexural strength and hardness of the 3D-printed resin material.

Color stability of a resin nanoceramic after surface treatments, adhesive cementation, and thermal aging

STATEMENT OF PROBLEM

Whether color changes in resin nanoceramic (RNC) restorations can occur because of material and adhesive interface degradation is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the color of RNCs submitted to surface treatments, cementation, and aging.

MATERIAL AND METHODS

RNC specimens (N=120) were produced with a thickness of 0.5 mm. The No Treatment-High/Low Translucency (NT-HT/LT) groups did not receive treatments; the Airborne-particle Abrasion-High/Low Translucency (AA-HT/LT) groups were airborne-particle abraded, and the Airborne-particle Abrasion Silane-High/Low Translucency (AASIL-HT/LT) groups received airborne-particle abrasion and a silane agent. Single specimens (n=60) were measured on a spectrophotometer before and after aging (50 000 cycles). The other half was mounted on composite resin bases and measured. The cleaned specimens were cemented (C) on the bases and measured (T0 and T1). ΔE₀₀, ΔL', ΔC', and ΔH' were obtained by using the CIEDE2000 formula and analyzed by using ANOVA and repeated-measures ANOVA. Multiple comparisons were made by using the Tukey HSD test (α=.05).

RESULTS

For single specimens, the greatest ΔE₀₀ values were observed in the AA-T1-LT resin (5.87). For mounted and cemented conditions, the greatest ΔE₀₀ values were found in the AA-C-T1-LT resin (1.74), and the ΔE₀₀ ranged from 0.75 (NT-OL) to 1.44 (AASIL-C-T1) for the HT resin (P<.001). The mounted and cemented specimens tended toward red and yellow, whereas lighter specimens were observed after cementation.

CONCLUSIONS

Aging affected the color of the RNCs evaluated. The single specimens showed greater color differences than the cemented specimens, reinforcing the importance of the adhesive cement in the optical behavior of thin restorations.

Effect of extended light activation and increment thickness on physical properties of conventional and bulk-filled resin-based composites

OBJECTIVES

To evaluate the biaxial flexural strength (BFS), flexural modulus (BFM), and Knoop microhardness (KHN) of incremental and bulk-filled resin-based composites (RBCs) using extended curing exposure times.

MATERIALS AND METHODS

Disc specimens (n = 8; 6-mm diameter) were fabricated using three stacked molds (0.5-mm thick for the top and bottom molds, and a 1-mm-thick center mold for the conventional and 3-mm thick for the bulk-fill RBCs). Conventional (Tetric EvoCeram/TCE and Filtek Z250/FIZ) and bulk-fill RBCs (Tetric EvoCeram Bulk Fill/TBF and Filtek One Bulk Fill Restorative/FOB) were evaluated. The stacked RBC-filled molds were light-cured for (1) the manufacturer-recommended exposure (MRE) duration; (2) 50%, and (3) 100% extension of the MRE. The BFS, BFM, and KHN of the top and bottom discs were measured. BFS and BFM were analyzed by three-way ANOVA (material*curing time*depth) and Tukey's post hoc (α = 0.05). KHN was analyzed by two-way ANOVA (curing time*depth) and Tukey's post hoc (α = 0.05).

RESULTS

Extending the exposure duration did not change the BFS and BFM on the top of the RBCs, but the BFS and KHN increased at the bottom of bulk-fill RBCs. For the conventional RBCs, TCE showed the highest increase on BFS at the bottom, going from 53.6 MPa at T1 to 69.9 at T3. Among the bulk-fill RBCs, FOB presented the highest increase on the bottom BFS (T1: 101.0 ± 19.9 MPa, T3: 147.6 ± 12.9 MPa). For all RBCs and exposure times, BFS and KHN were lower at the bottom. Only FIZ and FOB reached a bottom-to-top hardness ratio of 80%, at T3 and T2.

CONCLUSION

A significant increase on the BFS and KHN on the bottom of bulk-fill RBCs can be observed when the time of exposure to the curing light is double the MRE. However, extended exposure does not eliminate differences on the BFS and KHN between the shallow and deep regions of RBCs. TCE and TBF failed to reach an acceptable B/T hardness ratio at all evaluated exposure times.

CLINICAL RELEVANCE

Mechanical properties of RBCs can be affected by insufficient polymerization, specially at deeper regions of the increment. Therefore, clinicians should consider applying twice the MRE to curing-light to polymerize the maximal increment thickness of bulk-fill RBCs.

Spectrophotometric study determining staining tendency in different restorative materials (longitudinal in vitro study)

Aim

Our aim was to measure the discolouration degrees in a packable composite, zircon, ceramic, a flowable composite, and GIC (glass isomer cement) and to determine their tendencies to discolour to provide guidance to dentists and prosthodontist for choosing proper materials for cases in which aesthetics is the main treatment goal.

Materials and methods

Sixty discs were fabricated from the composite, zircon, ceramic, the flowable composite, and GIC, and natural teeth were the control group. The shades were recorded using the Ivoclar Vivadent Shade Guide, and readings were recorded from a Vita Easyshade 4.0 spectrophotometer before immersion, after 1 week, 2 weeks, 3 weeks, and 24 weeks of immersion in coffee. The analysis was performed using a SPSS paired t-test and CIE 76 formula.

Results

The ceramic had a starting shade of B1 and kept the same colour throughout the testing period. Zircon had a starting shade of A3 and transitioned to B3 by the second week. The composite had a shade of A1, and after the first week, it was A4; in the second week and afterwards, it was C4. The flowable composite had a starting shade of A1, and after one week, the shade was B3, and then after one more week A3.5; after five months, it was A4.

Conclusion

The ceramic showed no change, making it ideal for aesthetic regions and anterior replacements. Zircon had the second-highest colour stability, whereas all the other materials showed variable degrees of colour and surface changes, making them not ideal choices for anterior restorations. Thus, this information can aid choices for aesthetic regions to provide the highest longevity.

Evaluation of Color Changes of Different Resin Cements in Feldspathic Ceramic Crowns After Accelerated Aging: An In Vitro Research

Aims:

To evaluate the color changes that occur after accelerated aging in feldspathic ceramic crowns cemented with three different dual-cured resin cements.

Materials and Methods:

For each of the A2-colored RelyX U200, G-CEM LinkForce, and Panavia V5 cement groups, 45 dies from A2-colored zirconia blocks and 45 crowns from CEREC blocks were prepared. Color measurements after 24 h of cementation (T1) and after cycles of aging of 1750 (T2), 3500 (T3), and 7000 (T4) in the thermal cycle device were made using SpectroShade Micro device. The coordinates of the color were used L*, a*, and b* as base and the color change was calculated with ∆ E00 in determining the color. One-way analysis of variance test was used to compare the times in terms of ∆ L*, ∆ a*, and ∆ b* values.

Results:

It was found that ∆ L* value decreased significantly in period of the T2, T3, and T4 times compared to T1 in all groups ( P < .05), whereas the change between period of T2, T3, and T4 times was not significant ( P > .05). The ∆ a* value increased significantly in the period of T3 and T4 times compared to T1 in the only G-CEM LinkForce group, whereas the ∆ b* value increased significantly in the period of T4 time compared to T1 in the only Panavia V5 group. The changes in ∆ E00 values, which were observed in all period of times, were found to be between 0.43 and 1.04, 0.43 and 1.43, and 0.40 and 0.97 in RelyX U200, G-CEM LinkForce, and Panavia V5 groups, respectively.

Conclusion:

After accelerated aging, it was found that the color of all cements became darker and the G-CEM LinkForce group turned red and the Panavia V5 group turned yellow. However, it was found that the color changes that occurred were within clinically acceptable visible levels.

Effect of aging on color stability and bond strength of dual-cured resin cement with amine or amine-free self-initiators

This study aimed to evaluate the effect of aging on the color stability and bond strengths of dual-cured resin cements containing amine or amine-free self-initiators. Three dual-cured and one light-cured resin cements were used. The covered (by lithium disilicate ceramic disks) and uncovered groups (n=10) were included. Color measurements were tested after 24 h, 10,000 and 20,000 thermal cycles (TCs). Micro-shear bond strengths (µSBS) were tested after 24 h, 10,000 and 20,000 TCs, and failure modes were analyzed (n=14). Two-way ANOVA and Tukey's test were implemented for color difference (ΔE*_ab) and µSBS (α=0.05). The mean ΔE*_ab difference was significant among groups (p<0.001). The lowest ΔE*_ab values were obtained for dual-cured resin cement with amine-free self-initiators dual-cured cement after aging in all dual-cured resin cements, and the µSBS of the dual-cured resin cements on ceramic was significantly higher than that of the light-cured ones after aging (p<0.001).

Effect of combining photoinitiators on cure efficiency of dental resin-based composites

BACKGROUND

Camphorquinone is the most conventionally used photoinitiator in Dentistry. Although different alternative photoinitiators have been proposed, no photoinitiator was capable of completely substituting camphorquinone. The combination of photoinitiators has been considered the best alternative.

OBJECTIVES

To evaluate the effect of combining Norrish type I and II photoinitiators on the cure efficiency of dental resin-based composites.

METHODOLOGY

Experimental composites were produced containing different photoinitiator systems: Norrish type I-only, mono-alkyl phosphine oxide (TPO); Norrish type II-only, camphorquinone (CQ); or its combination, CQ and TPO, in a 1: 1 molar ratio. UV-vis absorption spectrophotometry was performed to assess the consumption of each photoinitiator after curing (n=3). A multi-wave LED (Bluephase® G2, Ivoclar Vivadent) was pre-characterized and used with a radiant exposure of 24 J/cm2. The degree of conversion was evaluated by Raman spectrometry, and the elution of the monomers by nuclear magnetic resonance analysis (n=3). Data were analyzed using ANOVA and Tukey's test (α=0.05; β=0.2).

RESULTS

The combination of CQ and TPO increased the consumption of the photoinitiator system compared to CQ-only (p=0.001), but presented similar consumption compared to TPO-only (p=0.52). There was no significant difference in the degree of conversion between the composites regardless of the photoinitiator system (p=0.81). However, the elution of the monomers was reduced when both photoinitiators were combined. TPO-based material presented the highest elution of monomers.

CONCLUSIONS

The combination of the photoinitiator systems seems to be beneficial for the cure efficiency of dental resin-based composites.

Physicochemical properties of dental resins formulated with amine-free photoinitiation systems

OBJECTIVE

To assess the mechanical properties of two different dimethacrylate resin blends containing the photosensitizer camphorquinone (CQ) alone or in combination with one or more synergists including an amine and/or an iodonium.

METHODS

Two co-monomer resin blends were formulated using Bis-GMA/TEGDMA and UDMA/TEGDMA, both at 1:1 mass ratio. Each resin blend was divided into four groups, comprising the following four photoinitiation systems: (1) CQ + 2-(dimethylamino)ethyl methacrylate (DMAEMA); (2) CQ + DMAEMA + bis(4-methyl phenyl)iodonium hexafluorophosphate (BPI); (3) CQ; and (4) CQ + BPI. Materials were evaluated for polymerisation kinetics, water sorption, solubility, flexural strength and modulus.

RESULTS

BisGMA/TEGDMA with CQ showed minimal and insignificant degree of conversion and was not tested for water sorption/solubility and mechanical properties. The ternary system (i.e., CQ + DMAEMA + BPI), promoted the highest degree of conversion for each monomer blend. The resins containing amine had higher mechanical properties than the amine free. However, the UDMA amine free resins exhibited greater flexural strength and modulus than the corresponding amine free BisGMA resins. BisGMA/TEGDMA containing CQ + DMAEMA or CQ + BPI had significantly higher water sorption and solubility than the other groups.

SIGNIFICANCE

Resins containing amine presented better properties than the amine-free systems. The addition of iodonium salt (BPI) improved the degree of conversion of the resins, even without an amine co-initiator. The amine-free initiator system (CQ + BPI) was more effective when used with UDMA versus BisGMA based-resins respectively.

Color stability and degree of conversion of a novel dibenzoyl germanium derivative containing photo-polymerized resin luting cement

AIM

To compare the color stability and degree of conversion (DC) of a resin cement containing a dibenzoyl germanium derivative photo-initiator (Variolink Esthetic) to resin cements containing conventional luting agents.

MATERIALS AND METHOD

Spectrophotometry and Fourier transform infrared spectroscopy (FTIR) were used to compare the color stability and DC, respectively, of Variolink Esthetic compared to Calibra, Variolink-N, and NX3 resin cements. Ten specimens (1 × 2 mm²) of each resin cement were photo-polymerized and then subjected to color stability assessments. In addition, 30 samples of each of the four resin cements were prepared and then immersed in three staining solutions (tea, coffee, and distilled water) for two weeks. Changes in color for the immersed versus non-immersed specimens (control specimens) were determined by comparing ΔL (lightness), Δa, and Δb (color components), and an overall ΔE (color difference) obtained from spectrophotometry assays. One-way analysis of variance and a multiple comparison test (Tukey's test) were used to analyze color stability and DC data. NX3 and Variolink Esthetic resin cements exhibited significantly lower values compared to the dual cured resin cements (Variolink-N and Calibra).

RESULTS

The highest DC values were observed among the photo-polymerized samples of Variolink Esthetic (87.18 ± 2.90%), while the lowest DC values were observed among the Variolink-N samples (44.55 ± 4.33%).

CONCLUSION

The resin cement, Variolink Esthetic, containing a novel dibenzoyl germanium derivative photo-initiator exhibited superior color stability (p < 0.05) and a higher DC than other resin cements containing conventional luting agents in an in vitro setting.

Evaluation of physico-mechanical properties and filler particles characterization of conventional, bulk-fill, and bioactive resin-based composites

OBJECTIVE

This study evaluated physical and mechanical properties and characterized the filler particles of seven composites.

MATERIALS AND METHODS

Filtek Supreme (FS, 3M Oral Care), Forma (FO, Ultradent), Charisma Diamond (CD, Kulzer), Spectra Smart (SS, Dentsply), Filtek Bulk Fill (FB, 3M Oral Care), Tetric N-Ceram Bulk Fill (TB, Ivoclar), and Cention N (Ivoclar) in self- (CNSC) or dual-curing (CNDC) were evaluated. Fillers size, shape, and content were analyzed by scanning electron microscopy (SEM) and X-ray dispersive energy spectroscopy (EDX). Disk-shaped specimens (n = 5) were prepared for sorption (SP) and solubility (SL). Flexural strength and elastic modulus were tested at 24 h and 12 months (n = 10). Degree of conversion (DC%) and maximum rate of polymerization (Rp^max) were evaluated using micro-Raman spectroscopy. SP and SL results were submitted to Kruskal-Wallis one-way ANOVA and Dunn's pairwise test (α = 0.05). Mechanical properties were analyzed by 2-way ANOVA and Tukey's test (α = 0.05). DC% of CNSC and CNDC was compared by independent t-test (α = 0.05). Rp^max results were analyzed by 1-way ANOVA and Tukey's test (α = 0.05).

RESULTS

The composites differed regarding filler size, shape, and content. CD and CNSC showed lower SP than FS. SS had lower SL than CNSC and CNDC. CNDC presented higher DC% than CNSC. CD, TB, and CNDC showed the highest Rp^max. TB, CNSC, and CNDC showed the lowest 24-h flexural strengths. Mechanical properties of CD did not decrease, while FO, TB, and CNSC showed a significant reduction after storage.

CONCLUSIONS

Monomer composition and fillers characteristics greatly influenced the physico-mechanical properties of the tested composites.

Evaluation of degree of conversion, rate of cure, microhardness, depth of cure, and contraction stress of new nanohybrid composites containing pre-polymerized spherical filler

The aim of the present study was to characterize nanohybrid and nanofilled composites in terms of degree of conversion (DC), rate of cure (RC), microhardness (Vickers hardness number; VHN), depth of cure, and contraction stress (CS). Ceram.X® universal- A3, duo enamel E2, and duo dentin D3 composites were compared to Tetric EvoCeram® and FiltekTMSupreme XTE composites of equivalent dentin and enamel shades under a 40 s photopolymerization protocol. DC was measured by infrared spectroscopy, calculating RC from the kinetic curve. Top and bottom VHN were determined using a Vickers indenter, and bottom/top surface ratio (Vickers hardness ratio; VHR) calculated. CS vs. time was assessed by a universal testing machine and normalized for the specimen bonding area. All materials showed DC  < 60%, Ceram.X® composites reaching higher values than the other composites of corresponding shades. RC at 5 s of photopolymerization was always higher than that at 10 s. All the Ceram.X® composites and the lighter-shaded Tetric EvoCeram® and FiltekTMSupreme XTE composites reached the RC plateau after 25 s, the remaining materials showed a slower kinetic trend. Tetric EvoCeram® and FiltekTMSupreme XTE composites displayed the softest and the hardest surfaces, respectively. Differently from darker-shaded materials, the universal and the three enamel-shaded composites resulted optimally cured (VHR >  80%). The tested composites differed in CS both during and after light cure, Tetric EvoCeram® and FiltekTMSupreme XTE composites displaying the highest and the lowest CS, respectively. Only the Ceram.X® universal-A3 reached a CS plateau value. The tested composites exhibited material-dependent chemo-mechanical properties. Increasing the curing time and/or reducing the composite layer thickness for dentin-shaded composites appears advisable.

New bulk-fill composite system with high irradiance light polymerization: Integrity and degree of conversion

OBJECTIVE

The study used optical coherence tomography (OCT) and micro Raman microscopy (mRM) to investigate internal defect (ID) and degree of conversion (DC) of two bulk-fill composite systems with high-irradiance or conventional light polymerization settings.

METHODS

The ID and DC of the new bulk-fill composites; Tetric PowerFill (PwrPst) and Tetric PowerFlow (PwrFlw) were compared with the predecessor bulk-fill composites; Tetric EvoCeram Bulkfill (EvoPst) and Tetric EvoFlow Bulkfill (EvoFlw), using LED light curing unit in two settings; normal (LED-Nrm: 1000 mW/cm², 10-s) or PowerCure (LED-Pwr: 3000 mW/cm², 3-s). ID formation was observed in bonded cylindrical composite cavities (4-mm depth, 3-mm diameter) using Yoshida Dental OCT. From the vertically projected 2D image, ID area percentage (ID-A%) was calculated. DC at the top and bottom and bottom/top DC ratio (DC-R%) of 4-mm thick discs was calculated using mRM. All data were statistically analyzed at significance level of α = 0.05.

RESULTS

Flowable composites in LED-Pwr showed smaller ID frequencies than other groups (PwrFlw: 0/8, EvoFlw: 2/8) (p < 0.05). Composite type significantly affected ID-A%, DC and DC-R% (p < 0.001), while light settings significantly affected ID-A% but not DC and DC-R% (p > 0.05). In both light settings, EvoPst showed the lowest DC-R% (<80%).

SIGNIFICANCE

Internal defect and degree of conversion of bulk-fill composites were affected by their composition and light settings. There was a tendency for less defects and better polymerization for the flowable bulk-fills. The new flowable bulk-fill composite with 3-seconds high irradiance light curing showed no defect formation.

Influence of beam homogenization on bond strength of adhesives to dentin

OBJECTIVE

This study evaluated the effect of beam homogeneity on the microtensile bond strength (μTBS) of two adhesive resins to dentin.

METHODS

One polywave light-emitting-diode (LED) LCU (Bluephase Style, Ivoclar Vivadent AG) was used with two different light guides: a regular tip (RT, 1010 mW/cm² emittance) and a homogenizer tip (HT, 946 mW/cm² emittance). The emission spectra and beam profiles were measured from both light guides. Extracted third molars were prepared for μTBS evaluation using two adhesive systems: Excite F (EXF) and Adhese Universal (ADU). Bond strength was calculated for each specimen (n = 10) at locations that correlated with the output of the two LED chips emitting blue (455 nm) and the one chip that emitted violet light (409 nm) after 24-hs and after one-year water-storage. The μTBS was analyzed using a four-way analysis of variance (factors: adhesive system, light guide, LED wavelength, and storage time) and post-hoc Tukey test (α = 0.05).

RESULTS

EXF always delivered a higher μTBS than ADU (p < 0.0001), with the μTBS of ADU being about 20% lower than EXF. The light guide (p = 0.0259) and storage time (p = 0.0009) significantly influenced the μTBS. The LED wavelengths had no influence on the μTBS (p > 0.05).

SIGNIFICANCE

Homogeneity of the emitted light beam was associated with higher 24-h μTBS to dentin, regardless of the adhesive tested. Also, differences in the composition of adhesives can affect their compatibility with restorative composites and their ability to maintain bonding over one year.

Vat photopolymerization 3D printing for advanced drug delivery and medical device applications

Three-dimensional (3D) printing is transforming manufacturing paradigms within healthcare. Vat photopolymerization 3D printing technology combines the benefits of high resolution and favourable printing speed, offering a sophisticated approach to fabricate bespoke medical devices and drug delivery systems. Herein, an overview of the vat polymerization techniques, their unique applications in the fields of drug delivery and medical device fabrication, material examples and the advantages they provide within healthcare, is provided. The challenges and drawbacks presented by this technology are also discussed. It is forecast that the adoption of 3D printing could pave the way for a personalised health system, advancing from traditional treatments pathways towards digital healthcare.

Bis(4-methyl phenyl)iodonium as an alternative component to diphenyliodonium in camphorquinone-based ternary initiating systems

OBJECTIVE

To evaluate the influence of different co-initiators (diphenyliodonium hexafluorophosphate - DPI - and bis(4-methyl phenyl)iodonium hexafluorophosphate - BPI) on chemical and mechanical properties of resins.

METHODS

Nine experimental resins (50% Bis-GMA and 50% TEGDMA, w/w) with 60 wt% filler particles were formulated. The initiating system used was camphorquinone (CQ-1 mol%) and ethyl dimethylaminobenzoate (EDAB-2 mol%). Experimental groups were established according to DPI and BPI quantities (0.25, 0.5, 0.75, and 1 mol%). The control group was a resin containing only CQ-EDAB. Light transmission through the resin during polymerisation was analysed with a UV-vis spectrophotometer. Real-time polymerisation of the systems was evaluated using an FTIR spectrometer. Real-time polymerisation shrinkage strain was evaluated, and the flexural strength and modulus of materials were obtained by 3-point bending. Experimental groups were statistically analysed by Analysis of Variance and Tukey's test (α = 0.05). Dunnett's test was applied to compare experimental groups with control.

RESULTS

Light transmission rapidly increased initially for resins containing DPI or BPI. After 30 s cure, the irradiance on the lower surface of resin specimens was similar for all groups. After 10 s of light irradiation, groups containing DPI and BPI had higher conversion than the control. However, conversion after 120 s post-irradiation was similar for all groups. The rate of polymerisation, shrinkage strain, and the maximum strain rate were higher for groups containing DPI/BPI. The use of iodonium salts increased the flexural strength and flexural moduli of resins.

SIGNIFICANCE

DPI and BPI increased resin reactivity similarly. Increased rate of polymerization influenced light transmission through the resin in the first seconds of polymerisation and increased resin shrinkage and rate of shrinkage, as well as flexural strength and moduli.

Depth-dependence of Degree of Conversion and Microhardness for Dual-cure and Light-cure Composites

CLINICAL RELEVANCE

New dual-cure bulk-fill composites show promise for uniform degree of conversion and microhardness throughout the entire depth of direct restorations.

SUMMARY

Influence of Different Cordless Light-emitting-diode Units and Battery Levels on Chemical, Mechanical, and Physical Properties of Composite Resin

Clinical Relevance

Irradiance may decrease as the light-emitting diode (LED) is discharged. Therefore, the LED must be charged carefully to prevent the possibility of influencing the chemical, mechanical, and physical properties of composite resin.

SUMMARY

The aim of this study was to evaluate the influence of different light-emitting diode (LED) curing units and battery levels on the chemical, mechanical, and physical properties of composite resins. The irradiance for each cycle from full to completely discharged battery level was evaluated, for five different new cordless LED units: Optilight Color (Gnatus), Bluephase (Ivoclar), Valo (Ultradent), Radii Plus (SDI), and Radii Xpert (SDI). After the irradiance evaluation, composite resin specimens were prepared and light cured, while varying the battery level for each LED unit: high level (HL, 100%), medium level (ML, 50%), and low level (LL, 10%). The degree of conversion, diametral tensile strength, sorption, and solubility were also evaluated. Data were checked for homoscedasticity and submitted to two-way and three-way analysis of variance, depending on the test performed, followed by the Tukey test with a significance level of 95%. A negative correlation was found between irradiance and cycles of light curing, which was checked by the Pearson correlation test. Valo and Radii Xpert were not influenced by the battery level in any test performed. However, different battery levels for some LED units can influence the degree of conversion, diametral tensile strength, sorption, and solubility of composite resins.

Influence of N-(2-hydroxyethyl)acrylamide addition in light- and dual-cured resin cements

OBJECTIVE

To develop experimental light-cured (L) and dual-cured (D) resin cements containing N-(2-hydroxyethyl)acrylamide and evaluate the physicochemical and optical properties.

METHODS

Experimental resin cements were formulated using bisphenol A-glycidyl dimethacrylate (70%) and 2-hydroxyethyl methacrylate (30%), in the control groups, and, bisphenol A-glycidyl dimethacrylate (70%) and N-(2-hydroxyethyl)acrylamide (30%). Polymerization kinetics were evaluated by differential scanning calorimetry (n = 3), softening in solvent (ΔKHN) evaluated by the difference of Knoop microhardness before (KHN₁) and after (KHN₂) ethanol solution immersion (n = 5), radiopacity in mmAl (n = 5), film thickness (n = 3) and color stability were evaluated. Mechanical properties as ultimate tensile strength (UTS) and micro-shear bond strength (μSBS) were analyzed immediately and after 6 months. Results were analyzed using ANOVA, Tukey's test and Student's t-test (α = 0.050).

RESULTS

The L_HEAA1 group had no statistical difference from the control group regarding polymerization kinetics, KHN₁, ΔKHN and color stability (p > 0.050). In dual-cured cements, the acrylamide groups presented a lower degree of conversion and higher ΔKHN than the D_HEMA0.6 group, which obtained a higher rate of polymerization (p < 0.050). There was no statistical difference in radiopacity and film thickness (p > 0.050). Dual-cured cements with N-(2-hydroxyethyl)acrylamide showed higher color change than methacrylates. Immediate mechanical properties were lower for acrylamide groups (p < 0.050), with higher hydrolytic stability.

CONCLUSIONS

The addition of N-(2-hydroxyethyl)acrylamide negatively affected the properties of the dual-cured resin cements. LHEAA1 did not differ in physicochemical and optical properties from the control, with higher hydrolytic stability.

CLINICAL SIGNIFICANCE

The results of the study indicate that acrylamides increased mechanical properties over time independently of the curing system mode, with more hydrolytic stability. The clinical performance of experimental resin cements should be evaluated.

The Use of Composite Layering Technique to Mask a Discolored Background: Color Analysis of Masking Ability After Aging—Part II

The aim of this study was to evaluate the effectiveness of the layering technique to mask a discolored background (C4) after one year of water aging. The technique was used with three resin composite restorative systems (IPS Empress Direct, Charisma Diamond, and Filtek Z350XT). Ninety 1.5-mm-thick specimens were divided into groups and subgroups according to the restorative system and resin composite shade combination used in the layering technique (enamel, body, and dentin). The color measurements were made by reflection spectrophotometer (SP60, EX-Rite) over the C4 substrate at two time points: after 24-hour water immersion (T0) and after one-year water aging (T1). The masking ability was evaluated by calculating the ΔE between an inherent color background and a C4 background at T0 and T1. CIELAB and CIEDE2000 formulas were used for comparative analysis between T0 and T1 color measurements. Analysis of variance and Turkey's post hoc test (a=0.05) were performed to analyze ΔEab and ΔE00 mean values. The Z350XT restorative system presented adequate masking ability in the combinations of 0.5 mm body + 1.0 mm dentin, 0.5 mm enamel + 1.0 mm dentin, and 1.5 mm dentin after 24-hour water immersion. The masking ability was affected negatively by water aging in most of the combinations. The IPS Empress Direct was the only system that remained stable after aging in the combinations of 0.5 mm enamel + 1.0 mm dentin and + 1.5 mm dentin (p=0.05 and p=0.47 for CIELAB; p=0.15 and p=0.51 for CIEDE2000), although it did not present adequate masking ability in both time points. None of the combinations of any system presented adequate masking ability after prolonged water aging.

Mechanical properties of experimental resin cements containing different photoinitiators and co-initiators

Aim

The aim of this study was to evaluate the influence of different concentrations of two photoinitiators and one co-initiator on the flexural strength (FS) and elastic modulus (E) of experimental resin cements.

Materials and methods

A mixture containing BisGMA, TEGDMA, and barium-aluminum-silicate (BaAlSi) and silanized colloidal silica (SiO₂) filler particles was prepared with two photoinitiators, viz. camphorquinone (CQ) and bisacylphosphine oxide (BAPO). Dimethylaminoethyl methacrylate (DMAEMA) was used as co-initiator. Thirty groups (n=10) were formulated with different photoinitiator systems (CQ/DMAEMA and BAPO/DMAEMA) and concentrations (wt%) of photoinitiator and co-initiator. The photoactivation was carried out for 20 s with a light-emitting diode (LED, Bluephase, Ivoclar Vivadent) with irradiance of 1200 mW/cm². The FS and E were obtained in a three-point bending test on a universal testing machine (0.5 mm/min). Data were subjected to the Kolmogorov-Smirnov normality test, followed by two-way ANOVA and Tukey’s test (α=0.05).

Results

No polymerization occurred in the CQ groups without DMAEMA (0 wt%). DMAEMA 0.5 %wt and 1 %wt groups showed statistically similar FS and E results for CQ and BAPO, except for CQ 0.3 wt% (FS), CQ 0.9wt% (E) and BAPO 1.76 wt% (FS and E) for DMAEMA 0.5 %wt. No significant difference was found for FS and E values for different concentrations of photoinitiators, except for CQ 0.25 wt% (FS and E) and BAPO 0.25 wt% (E) that showed the lowest values.

Conclusion

The wt% of the photoinitiators and co-initiator influenced the mechanical properties and the performance of CQ was dependent on the DMAEMA concentration. BAPO can be used as substitute for the conventional CQ/DMAEMA photoinitiator system.

Different depth-related polymerization kinetics of dual-cure, bulk-fill composites

OBJECTIVE

The aim of this study was to evaluate the polymerization kinetics qualitatively and quantitatively for dual-cure bulk-fill composites in comparison with light-cure bulk-fill and traditional incremental composites at two clinically relevant depths.

METHODS

Five commercial dental composites were evaluated, including three dual-cure bulk-fill composites (BulkEZ, HyperFIL and Injectafil), one light-cure bulk-fill composite Filtek Bulk Fill Flowable (FBF) and one traditional incremental composite Filtek Z250 (Z250) as controls. Specimens were prepared in two different depths (0.5 mm and 5 mm) for 20 s light irradiation. Self-cure was also evaluated for the three dual-cure composites. The polymerization kinetics were measured continuously in real-time for at least 10 min using a Fourier-transform infrared spectroscopy (FTIR) with an attenuated total reflectance (ATR) accessory. The experimental kinetic data were fitted using two mathematical models - a sigmoidal function and a superposition of two exponential functions characterizing the gel phase and glass phase. The degree of conversion (DC) and the rate of polymerization were calculated for all test conditions.

RESULTS

Both experimental FTIR measurements and mathematical modeling revealed distinct depth-related polymerization kinetics for BulkEZ compared to the other two dual-cure composites. Specifically, BulkEZ exhibited moderately-paced polymerization kinetics at both depths while HyperFIL and Injectafil exhibited faster polymerization at 0.5 mm and slower polymerization at 5 mm. The bulk-fill FBF and incremental Z250 exhibited relatively fast polymerization at both depths, a characteristic for light-cure. The DC values at the two depths were not significantly different for BulkEZ, but significantly higher at 0.5 mm than at 5 mm for the other four composites (α = 0.05).

SIGNIFICANCE

Polymerization kinetics and their depth variation for dual-cure bulk-fill composites are material dependent. The distinct depth-related polymerization kinetics revealed for BulkEZ compared to other composites may affect their contraction stress and clinical performance.

The Use of Different Photoinitiator Systems in Photopolymerizing Resin Cements Through Ceramic Veneers

OBJECTIVE

To evaluate the effect of different photoinitiator systems on photopolymerizing resin cements through ceramic veneers with different thickness on microshear bond strength (μSBS), flexural strength (FS), and ultimate tensile strength (UTS) and verify the light attenuation through these ceramic veneers.

METHODS AND MATERIALS

Four photopolymerizing experimental resin cements were produced with the same resin matrix and associated with four different photoinitiator systems: camphorquinone (CQ), diphenyl(2,4,6-trimethylbenzoyl)phosphine oxide (TPO), Ivocerin, and TPO + Ivocerin. Eighty disc-shaped ceramic veneers (IPS Empress Esthetic, Ivoclar Vivadent) were fabricated (10-mm diameter) in two different thicknesses: 0.7 and 1.5 mm. A previously characterized multiwave LED (Bluephase G2, Ivoclar Vivadent) was standardized for 40 seconds of photoactivation. Light transmittance through each ceramic veneer thickness (n=5) was measured using a spectrometer (USB 2000, Ocean Optics). The μSBS of each resin cement (n=15) to the ceramic veneer was evaluated using 0.5-mm cylinders with 0.7-mm diameters photoactivated through the different ceramic veneer thicknesses. Samples for FS and UTS tests were made either with or without ceramics veneers (0.7 and 1.5 mm) fixed to the light-curing tip. Data were submitted to two-way analysis of variance and the Tukey test (α=0.05).

RESULTS

The multiwave LED emitted higher irradiance into the blue wavelength spectra than into the violet wavelength spectra (p=0.0001). Light transmittance through the ceramic veneers was reduced in a systematic manner based on thickness regardless of the wavelength spectra emitted from the multiwave LED (p=0.00037). The μSBS was reduced in a systematic manner based on thickness regardless of the photoinitiator system (p<0.05). However, resin cements with CQ and Ivocerin showed higher bond strength values in comparison to the resin cement with TPO regardless of the ceramic veneer thickness (p<0.05). The FS and UTS means decreased (p<0.05) with the interposition of 0.7- and 1.5-mm ceramic veneers for all resin cements. The resin cement containing only TPO showed the lowest FS and UTS means (p<0.05) for all ceramic veneers.

CONCLUSIONS

The thickness of the ceramic veneers reduced the irradiance of the multiwave LED in all wavelength spectra. Ivocerin alone or associated with TPO showed to be an effective alternative photoinitiator to substitute for CQ. The resin cement containing only TPO had lower bond strength values in comparison to resin cements with CQ, Ivocerin, and Ivocerin + TPO.

Mechanical properties and radiopacity of flowable fiber-reinforced composite

The aim was to evaluate the effect of different zirconia discontinuous fiber fractions on radiopacity and other selected properties of glass discontinuous fiber-reinforced flowable composite (Exp-SFRC). Exp-SFRC was prepared by mixing 30 wt% of resin-matrix and 45 wt% of particulate-fillers to 25 wt% of various weight-fractions of E-glass/zirconia discontinuous fiber-fillers (25:0, 20:5, 15:10, 10:15, 0:25 wt%). Flexural strength and fracture toughness were determined for each experimental material. Radiograph of each Exp-SFRC and aluminium step wedge were taken to determine the radiopacity. Degree of conversion and light-transmission were also measured. Scanning electron microscopy was used to evaluate the microstructure of the Exp-SFRC. Analysis of variance (ANOVA) revealed that fractions of E-glass/zirconia discontinuous fiber-fillers had significant effect (p<0.05) on radiopacity and other tested properties of the Exp-SFRCs. Replacing low fraction of E-glass fiber with zirconia fiber-fillers can increase the radiopacity of the fiber-reinforced composite without deteriorating the mechanical properties, although, degree of conversion was decreased.

Comparison to Color Stability Between Amine with Benzoyl Peroxide Includes Resin Cement and Amine-reduced, Amine-free, Lacking of Benzoyl Peroxide Resin Cements After Thermocycle

Objective:

This study aims to compare the color change (Δ E) of 5 resin cements (Panavia SA, Panavia V5, RelyX U200, Variolink NLC clear and +1) after thermocycling. Changes in color of specimens were determined after 10,000 cycles of thermocycling by spectrophotometer in the CIELAB.

Materials and Methods:

Ceramic disks, simulating laminate veneers, with thicknesses of 0.5, 0.7, and 1.0 mm (A1, IPS e.max) were fabricated. Color differences (Δ E) between the control and test groups were calculated. Data were statistically analyzed by 2-way analysis of variance (ANOVA). Also, Tukey’s multiple comparison tests were applied to know the difference between the groups (α = 0.05).

Results:

The factors of cement type and thickness of ceramic showed significant influence on Δ E values ( P < .05). After thermocycling, all resin cements, except benzoyl peroxide including resin cement (Pan SA), were showed clinically acceptable to color change limits (Δ E < 3.3). On evaluating the effects of ceramic thickness on color change after thermocyle aging, control group (no ceramic thickness) showed color change ( P < .05) visually.

Conclusion:

Amine-reduced, amine-free and lacking benzoyl peroxide resin cement showed minimal color change and better color stability.

Effect of previous photoactivation of the adhesive system on the color stability and mechanical properties of resin components in ceramic laminate veneer luting

STATEMENT OF PROBLEM

The color stability and mechanical properties of luting agents influence the esthetics and longevity of ceramic restorations. However, studies evaluating the color changes and mechanical properties of luting agents under ceramic laminates activated by using different methods are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the effects of different modes of photoactivation on the nanohardness and elastic modulus of resin cements and dental adhesives and on the color stability of ceramic laminate veneers.

MATERIAL AND METHODS

Forty-four lithium disilicate blocks (7×8×0.6 mm) were cemented onto bovine enamel and divided into 4 groups according to the polymerization light (Radii-Cal or Valo) used and the mode of activation of the dental adhesive (no previous photoactivation or previous photoactivation). Single Bond Universal dental adhesive and RelyX Veneer resin cement were used in all experimental groups. Color stability was measured using a UV-2450 ultraviolet-visible spectrophotometer before and after ultraviolet-B artificial accelerated aging (n=8). The nanohardness and the elastic modulus of the adhesive and resin cement were measured using a nanohardness tester (n=3). The color stability and mechanical properties were measured and analyzed using ANOVA and the Tukey least significant difference test (α=.05).

RESULTS

No difference in color stability or mechanical properties of the resin cement among the polymerization lights was detected (P>.05). Specimens that underwent previous photoactivation of the adhesive using the Valo polywave unit exhibited higher elastic modulus values than those that did not undergo previous photoactivation (P<.001).

CONCLUSIONS

The Valo polywave polymerization light improved mechanical properties and color stability more than the Radii-Cal unit. Previous activation of the dental adhesive in the dental enamel with the Valo polywave polymerization light yielded more satisfactory results.

Efficiency of light curing units in a government dental school

The light intensity of a light-curing unit is a crucial factor that affects the clinical longevity of resin composites. This study aimed to investigate the efficiency of light-curing units in use at a local governmental dental school for curing conventional and bulk-fill resin materials. A total of 166 light-curing units at three locations were examined, and the brand, type, clinic location, diameter of curing tip, tip cleanliness (using a visual score), and the output (in mW/cm² using a digital radiometer) were recorded. Only 23.5% of the units examined had clean tips, with the graduate student clinical area containing the highest percentage of clean tips. Further, tips with poor cleanliness score values were associated with significantly lower output intensities. A small percentage (9.4%) of units was capable of producing intensities higher than 1,200 mW/cm² and lower than 600 mW/cm² (7.6%). The majority of the low intensity units were located in the undergraduate student area, which also contained the highest number of units with intensities between 900 and 1,200 mW/cm². The output of all the units in service was satisfactory for curing conventional resin composites, and most units were capable of curing bulk-fill resin materials.