Polymerization development of "low-shrink" resin composites: Reaction kinetics, polymerization stress and quality of network

Study of high-strength, low-shrinkage dental resin composites with bifunctional polysilsesquioxane

OBJECTIVES

The aim of this study was to develop a new composite resin to solve the problem of volume shrinkage of conventional dental restorative composite resins during the curing process in order to improve their mechanical properties and reduce the risk of restoration failure.

METHODS

We synthesized the mercapto-alkenyl click chemical reaction product (MN-POSS) of acrylate-based POSS (MAP-POSS) with N-Acetylcysteine (NAC) using a bifunctional polysilsesquioxane modification technique and improved its dispersion in the resin matrix by physicochemical methods. In addition, methacrylate-based epoxy POSS (ME-POSS) was further synthesized and used to modify acrylate dental resins to form a free radical-cation hybrid light-curing system.

RESULTS

The results showed that the composites modified with MN-POSS significantly improved mechanical strength, while the application of ME-POSS effectively reduced polymerization shrinkage, improved the water absorption and dissolution properties of the materials, and enhanced mechanical properties and hardness. This study provides new ideas and material solutions to improve the performance of dental restorative materials.

SIGNIFICANCE

Both of these improved solutions demonstrate the potential of bifunctional POSS as a modified filler, providing new ideas and methods for the design of future dental restorative materials.

Effect of ceramic thickness on the polymerization quality and film thickness of dual-polymerizing versus heated light-polymerizing adhesive cement

STATEMENT OF PROBLEM

The clinical success of ceramic veneers cemented with preheated composite resin has been reported to be acceptable. Although the cementing technique requires sufficient light energy to activate its polymerization, the ability of light to penetrate through ceramic restorations of different thicknesses is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the polymerization quality and bond joint thickness of a dual-component adhesive and a heated composite resin when bonding ceramic onlays of varying thicknesses.

MATERIAL AND METHODS

Sixty noncarious maxillary premolars, extracted for orthodontic or periodontal reasons, were divided into 6 groups (n=10) and sectioned apically to the marginal ridge. Computer-aided design and computer-aided manufacturing (CAD-CAM) was used to create onlays of varying thicknesses. Following the manufacturers ' instructions, the onlays were cemented using a dual-polymerizing resin for group DP1, DP2, and DP3 groups and preheated light-polymerizing resin for groups LP1, LP2, and LP3. The numbers indicate onlay thickness in each group. Vickers testing was performed 24 hours after polymerization, with a 0.49-N static load applied for 10 seconds. Film thickness was analyzed under an optical microscope, and temperature changes were measured using a thermal imaging camera. Statistical analysis was done with the 2-factor mixed ANOVA tests (α=.05).

RESULTS

The Vickers hardness of a dual-polymerizing cement was lower compared with heated light-polymerizing cement (P<.05). Moreover, the thickness of the resin-ceramic restoration did not significantly affect the polymerization of a dual-polymerizing cement. However, the polymerization of the preheated light-polymerizing composite resin in group LP3 was significantly lower compared with other thicknesses (P<.05). In group LP3, the Vickers hardness of the tooth adjacent to the surface of the cement (DX2) was lower compared with indentations closer to the restoration surface (DX3, DX6), demonstrating a reduction in polymerization in the internal part. In addition, the mean film thickness of the dual-polymerizing groups (96 ±18 µm) was significantly lower than of the heated light-polymerizing groups (294 ±64 µm) (P<.05). A temperature reduction of 15 °C in the heated composite resin was also observed after 8 seconds CONCLUSIONS: The thickness of the ceramic restoration did not significantly affect the polymerization of a dual-polymerizing cement. However, the polymerization of the preheated light-polymerizing composite resin under the same ceramic restoration with a thickness of 3 mm was significantly lower. In addition, the mean film thickness for the dual-polymerizing composite resin groups was significantly lower than for the heated light-polymerizing composite resin groups.

Current approaches to produce durable biomaterials: Trends in polymeric materials for restorative dentistry applications

Dental caries continues to be a public health issue, especially more evident in underserved populations throughout the U.S. Unfortunately, especially with an aging population, hundreds of thousands of resin composite restorations are replaced each year due to recurring decay and fracture. According to several cohort studies, the average life span of this type of restoration is 10 years or less, depending on the caries risk level of the patient and the complexity of the restorative procedure. Any new material development must depart from the simple restoration of form paradigm, in which the filling is simply inert/biocompatible. This review will discuss novel antibiofilm structures, based on a targeted approach specifically against dysbiotic bacteria. Biofilm coalescence can be prevented by using glycosyl transferase - GTF inhibitors, in a non-bactericidal approach. On the tooth substrate side, MMP-inhibiting molecules can improve the stability of the collagen in the hybrid layer. This review will also discuss the importance of testing the materials in a physiologically relevant environment, mimicking the conditions in the mouth in terms of mechanical loading, bacterial challenge, and the presence of saliva. Ultimately, the goal of materials development is to achieve durable restorations, capable of adapting to the oral environment and resisting challenges that go beyond mechanical demands. That way, we can prevent the unnecessary loss of additional tooth structure that comes with every re-treatment. CLINICAL SIGNIFICANCE: While proper restorative technique and patient education in terms of diet and oral hygiene are crucial factors in increasing the longevity of esthetic direct restorations, materials better able to resist and interact with the conditions of the oral environment are still needed. Reproducing the success of dental amalgams with esthetic materials continues to be the Holy Grail of materials development.

Degree of conversion and interfacial adaptation of touch-cure resin cement polymerized by self-curing or dual-curing with reduced light

OBJECTIVES

The first aim of this study was to determine whether there is a difference in degree of conversion (DC) of touch-cure cements polymerized by self-curing with adhesive or dual-curing under reduced light. The second aim was to compare interfacial adaptation of zirconia restoration cemented using touch-cure cements self-cured or dual-cured by reduced light.

METHODS

The DC of touch-cure resin cements with adhesive was measured continuously using Fourier transform infrared spectrometry. Experimental groups differed depending on touch-cure cement. Each group had three subgroups of polymerization method. For subgroup 1, the DC was measured by self-curing. For subgroups 2 and 3, the DCs were measured by dual-curing with reduced light penetrating 3 mm and 1 mm zirconia blocks, respectively. For interfacial adaptation evaluation, Class I cavity was prepared on an extracted third molar, and zirconia restoration was fabricated. The restoration was cemented using the same cement. Groups and subgroups for interfacial adaptation were the same as those of the DC measurement. After thermo-cycling, interfacial adaptation at the tooth-restoration interface was evaluated using swept-source optical coherence tomography imaging.

RESULTS

The DC of touch-cure cement differed depending on the measurement time, resin cement, and polymerization method (p < 0.05). Interfacial adaptation was different depending on the resin cement and polymerization method (p < 0.05).

CONCLUSION

For touch-cure cement, light-curing with higher irradiance presented a higher DC and superior interfacial adaptation than light-curing with lower irradiance or self-curing.

CLINICAL RELEVANCE

Although some adhesives accelerate the self-curing of touch-cure cement, light-curing for touch-cure cement is necessary for zirconia cementation.

A Historical Perspective on Dental Composite Restorative Materials

This review article will discuss the origin of resin-based dental composite materials and their adoption as potentially useful adjuncts to the primary material used by most dentists for direct restorations. The evolution of the materials, largely driven by the industry's response to the needs of dentists, has produced materials that are esthetic, strong, and versatile enough to be used in most areas of the oral cavity to replace or restore missing tooth structures. Significant advancements, such as the transition from chemical to light-curing materials, refinements in reinforcing particles to produce optimum polishing and wear resistance, formulating pastes with altered viscosities to create highly flowable and highly stiff materials, and creating materials with enhanced depth of cure to facilitate placement, will be highlighted. Future advancements will likely reflect the movement away from simply being a biocompatible material to one that is designed to produce some type of beneficial effect upon interaction within the oral environment. These new materials have been called "bioactive" by virtue of their potential effects on bacterial biofilms and their ability to promote mineralization of adjacent tooth structures.

Relaxation mechanisms in low-stress polymer networks with alternative chemistries

Background

Low-stress resin-based composites (RBCs) are available to the clinician, some using stress relaxation mechanisms on the basis of network reconfiguration, modulated photopolymerization, or chain transfer reactions. This study investigated those materials in terms of their overall stress relaxation and their relationship with polymerization kinetics and compared them with an experimental low-stress thiourethane (TU) material.

Methods

Experimental composites (bisphenol-A-diglycidyl dimethacrylate, urethane dimethacrylate, and triethylene glycol dimethacrylate [50:30:20 mass ratio]; 70% barium aluminosilicate filler; camphoroquinone, ethyl-4-dimethylaminobenzoate, and 2,6-di-tert-butyl-4-methylphenol [0.2:0.8:0.2% by mass]) with or without TU oligomer (synthesized in-house) and commercial composites (SureFil SDR Flow+ Posterior Bulk Fill Flowable Base [SDR Flow+] [Dentsply Sirona], Filtek Bulk Fill Posterior Restorative [3M ESPE], and Filtek Supreme Ultra Universal Restorative [3M ESPE]) were tested. Polymerization kinetics (near-infrared) and polymerization stress (Bioman) were evaluated during light-emitting diode photoactivation at 100 mW/cm2 for 20 seconds. Stress relaxation was assessed using dynamic mechanical analysis. Data were analyzed with a 1-way analysis of variance and Tukey test (α = 0.05).

Results

The kinetic profiles of all materials differed substantially, including more than a 2-fold difference in the rate of polymerization between TU-modified composites and SDR Flow+. TU-modified RBCs also showed more than a 2-fold higher conversion at the onset of deceleration vs the experimental control and commercial materials. RBCs that used stress reduction mechanisms showed at least a 34% reduction in polymerization stress compared with the controls and significantly reduced the amount of early-onset stress buildup. SDR Flow+ and the TU-modified RBCs showed the greatest amount of viscoelastic stress relaxation postpolymerization.

Conclusions

The novel TU-modified materials showed similar or improved performance compared with commercial low-stress RBCs, showing that chain transfer may be a promising strategy for stress reduction, both during polymerization and after polymerization.

Engineering a versatile and retrievable cell macroencapsulation device for the delivery of therapeutic proteins

Encapsulated cell therapy holds a great potential to deliver sustained levels of highly potent therapeutic proteins to patients and improve chronic disease management. A versatile encapsulation device that is biocompatible, scalable, and easy to administer, retrieve, or replace has yet to be validated for clinical applications. Here, we report on a cargo-agnostic, macroencapsulation device with optimized features for protein delivery. It is compatible with adherent and suspension cells, and can be administered and retrieved without burdensome surgical procedures. We characterized its biocompatibility and showed that different cell lines producing different therapeutic proteins can be combined in the device. We demonstrated the ability of cytokine-secreting cells encapsulated in our device and implanted in human skin to mobilize and activate antigen-presenting cells, which could potentially serve as an effective adjuvant strategy in cancer immunization therapies. We believe that our device may contribute to cell therapies for cancer, metabolic disorders, and protein-deficient diseases.

Tailoring the monomers to overcome the shortcomings of current dental resin composites - review

Dental resin composites (DRCs) have become the first choice among different restorative materials for direct anterior and posterior restorations in the clinic. Though the properties of DRCs have been improved greatly in recent years, they still have several shortcomings, such as volumetric shrinkage and shrinkage stress, biofilm development, lack of radio-opacity for some specific DRCs, and estrogenicity, which need to be overcome. The resin matrix, composed of different monomers, constitutes the continuous phase and determine the performance of DRCs. Thus, the chemical structure of the monomers plays an important role in modifying the properties of DRCs. Numerous researchers have taken to design and develop novel monomers with specific functions for the purpose of fulfilling the needs in dentistry. In this review, the development of monomers in DRCs were highlighted, especially focusing on strategies aimed at reducing volumetric shrinkage and shrinkage stress, endowing bacteriocidal and antibacterial adhesion activities as well as protein-repelling activity, increasing radio-opacity, and replacing Bis-GMA. The influences of these novel monomers on the properties of DRCs were also discussed.

Low-Shrinkage Resin Matrices in Restorative Dentistry-Narrative Review

Dimethacrylate-based resin composites restorations have become widely-used intraoral materials in daily dental practice. The increasing use of composites has greatly enhanced modern preventive and conservative dentistry. They have many superior features, especially esthetic properties, bondability, and elimination of mercury and galvanic currents. However, polymeric materials are highly susceptible to polymerization shrinkage and stresses that lead to microleakage, biofilm formation, secondary caries, and restoration loss. Several techniques have been investigated to minimize the side effects of these shrinkage stresses. The primary approach is through fabrications and modification of the resin matrices. Therefore, this review article focuses on the methods for testing the shrinkage, as well as formulations of resinous matrices available to reduce polymerization shrinkage and its associated stress. Furthermore, this article reviews recent cutting-edge developments on bioactive low-shrinkage-stress nanocomposites to effectively inhibit the growth and activities of cariogenic pathogens and enhance the remineralization process.

Polymer characteristics and mechanical properties of bulk-fill, giomer, fiber-reinforced and low-shrinkage composites

Introduction/Objective. The objective was to determine the degree of conversion (DC), cross-link density, percentage of leachable monomers, flexural strength (FS), and hardness (HV) of nanohybrid, nanofilled bulk-fill, giomer, fiber-reinforced, and low-shrinkage composites. Methods. Standardized specimens (n = 5/group) of Tetric EvoCeram Bulk Fill, Filtek Bulk Fill, Beautifil, EverX posterior, Kalore, Filtek Z250 (microhybrid control), and Tetric EvoCeram (nanohybrid control) were subjected to micro-Raman spectroscopy, three-point bending, and HV. Cross-linking density and leachable monomers were ascertained based on the ratio of HV and DC before and after immersion in absolute ethanol. Results. DC was in the range 50.4?70.5%, the highest for Filtek Bulk and the lowest for Kalore. The highest %DC change was in Beautifil (10.3%) and the lowest in Filtek Bulk (1.4%) and Z250 (1.28%). FS ranged between 78.9 MPa (TEC) and 126.7 MPa (Filtek Bulk). HV ranged between 58.6 (Kalore) and 113.9 (Z250) and significantly decreased post-immersion (19?55%). HV48h inversely correlated to HV% loss (r = -0.761), whilst DC positively correlated with FS (r = 0.893). Conclusion. Filtek Bulk, EverX, and Z250 showed the highest DC. The lowest DC and mechanical properties were observed for Kalore. The greatest cross-link density was shown by Filtek Bulk. There were up to 10% of leachable monomers. DC and FS positively correlated.

Evaluation of the Water Sorption and Solubility Behavior of Different Polymeric Luting Materials

Objective: The study evaluated the water sorption (WSP) and water solubility (WSL) characteristics of different luting agents over a 180-day water storage period. Materials and Methods: Nine luting materials, i.e., conventional resin cement: Panavia F (PF), Rely X ARC (RA), self-adhesive resin cement: Rely X Unicem (RU), Breez (BZ), Maxcem Elite (MX), BisCem (BC) and resin-modified glass ionomer cement: FujiCem (FC), FujiPlus (FP) Rely X luting plus (RL) were assessed and fifty-two-disc specimens of each material were fabricated. All specimens were desiccated until a constant weight (W0) was reached. Thirteen specimens for each luting material were then randomly assigned to one of the four water immersion periods (7, 30, 90, and 180 days). After each period, the specimens were removed from the water and weighed to get W1. The samples were again desiccated for a second time and W₂ was measured. Both WSP and WSL were determined by the following equations: WSP (%) = (W₁ − W₂) × 100/W₀ and WSL (%) = (W₀ − W₂) × 100/W₀. Assessments were performed following ISO standards. ANOVA was used to assess the effect of luting agent and time period on water sorption and solubility. Pair-wise comparisons were adjusted using Tukey’s multiple comparison procedure. A significance level of 0.05 was used for all statistical tests. Results: The highest mean WSP and WSL (WSP/WSL) were demonstrated by resin-modified glass-ionomers (RL 18.32/3.25, FC 17.08/4.83, and FP 14.14/1.99), while resin luting agents showed lower WSP and WSL results (PF 1.6/0.67 and RA 1.76/0.46), respectively. The self-adhesive agents exhibited a wide range of WSP and WSL values (RU 1.86/0.13, BZ 4.66/0.93, and MX 3.68/1.11). Self-adhesive cement showed lower WSP and WSL compared with the resin-modified glass-ionomers (p < 0.05). All the materials reached equilibrium after 90-days. Conclusions: Resin-based luting materials have the lowest sorption and solubility. Rely X Unicem self-adhesive luting materials were comparable to resin luting materials for WSL and WSP. Resin-modified glass-ionomer showed the highest water sorption and solubility compared with both resin and self-adhesive materials.

Development of image analysis using Python: Relationship between matrix ratio of composite resin and curing temperature

The aim of this study was to establish a measurement method for filler and matrix in cured resin composite (RC) using Python programming and to investigate the correlation between matrix ratio and curing temperature rise. Eight kinds of RCs were used. Backscattered electron images were taken for each cured specimen. Matrix and filler contents were calculated using Python programming with the K-means or area segmentation method. Volume measurement methods were assessed for comparison. Heat released during the polymerization reaction was measured. The matrix ratio was calculated without human intervention. Three specimens contained only inorganic filler, and other specimens contained multiple types of fillers. Almost the same values of the matrix ratio were obtained by programming and the volume measurement methods for specimens containing a single type of inorganic filler. Moreover, a strong correlation was found between the matrix ratio obtained by the programming method and curing temperature rise (R=0.9826).

Antibacterial and thermomechanical properties of experimental dental resins containing quaternary ammonium monomers with two or four methacrylate groups

Resins with strong antibacterial and thermomechanical properties are critical for application in oral cavities. In this study, we first evaluated the antibacterial effect of an unfilled resin incorporating 1, 4, and 7 mass% of quaternary ammonium salt (QAS) monomers containing two methacrylate groups (MAE-DB) and four methacrylate groups (TMH-DB) against Streptococcus mutans, and tested the cytotoxicity and thermomechanical properties of the 4 mass% MAE-DB and TMH-DB modified resin materials. A neat resin without a QAS monomer served as the control. As the concentration of both QAS monomers increases, the formation of a Streptococcus mutans biofilm on the experimental material is increasingly inhibited. The results of colony forming unit counts and the metabolic activity showed that both the MAE-DB and TMH-DB modified resins have a strong bactericidal effect on the bacteria in a biofilm, but no bactericidal effect on the bacteria in a solution. The viability-staining and morphology results also demonstrate that the bacteria deform, lyse, shrink, and die on the surface of the two QAS-modified resins. Cytotoxicity results show that the addition of TMH-DB can reduce the cytotoxicity of the resin, while the addition of MAE-DB increases the cytotoxicity of the resin. DMA results show that a TMH-DB modified resin has a higher storage modulus than a MAE-DB modified resin owing to its better crosslink density. The two groups of experimental resins showed a similar glass transition temperature. These data indicate that the two QAS monomers can impart similar antibacterial properties upon contact with a dental resin, whereas TMH-DB can endow the resin with a higher crosslink density and storage modulus than MAE-DB because it has more polymerizable groups.

Resins with strong antibacterial and thermomechanical properties are critical for application in oral cavities.

Shrinkage characteristics of a novel lower contractile acrylic pattern resin

Forming models and brazing parts, both of which require high accuracy, are greatly affected the polymerization shrinkage of pattern resin. In 2018, a lower-shrinkage autopolymerizing pattern resin (PRK) was introduced. In this work, we compared the rate of polymerization shrinkage between PRK with that of three autopolymerizing resins -GC Pattern Resin (GPR), Pi-Ku Plast (PIK), and Fixpeed (FIX)- as controls. The shrinkage percentages at 10 min were 7.26±0.88 for PRK, 10.78±2.28 for GPR, 8.03±1.08% for PIK, and 7.46±1.25 for FIX. The shrinkage of PRK was significantly lower than that of GPR. The lower-shrinkage autopolymerizing resin contains some multifunctional monomer and indicated that the amount of monomer was accordingly reduced from the result of polymer size and abundance ratio. Our results suggested that the monomer component and the polymer particle size were factors that contribute to reducing contraction of the resins.

Preparation of a highly crosslinked biosafe dental nanocomposite resin with a tetrafunctional methacrylate quaternary ammonium salt monomer

The design of antimicrobial dental nanocomposite resin to prevent secondary dental caries and minimize biosafety problems is an important endeavor with both fundamental and practical implications.

Physical and photoelastic properties of bulk-fill and conventional composites

Purpose

This study evaluated the influence of thickness increment on degree of conversion (DC), Knoop microhardness (KHN), and polymerization-shrinkage stress (PSS) by photoelasticity of three dental composites.

Methods

For DC and KHN, 45 samples were prepared and divided into nine groups (n=5), according to composite (microhybrid [Filtek Z250 - Z250], bulk-fill flowable [SureFil SDR Flow - SDR], and nanohybrid composite [N’Durance - NDU]) and increment thickness (1, 1.5, and 3 mm). PSS was measured by photoelastic analysis. Composites were placed into a photo-elastic model cavity and light-cured. DC and KHN data were subjected to two-way ANOVA and Bonferroni post hoc test. PSS results were qualitatively evaluated through Kruskal–Wallis test.

Results

SDR showed the highest DC values. At top and bottom surfaces, the highest KHN was obtained by Z250. Z250 showed higher PSS than SDR in 1.5 mm increments. NDU showed higher PSS than SDR in 3 mm increments.

Conclusion

The bulk-fill composite demonstrated better DC and similar KHN and PSS in deeper layers compared to conventional composites. Bulk-fill composites may perform as well as conventional nanohybrid and microhybrid composites.

The Silorane-based Resin Composites: A Review

This article aims to review the research done on the silorane-based resin composites (SBRC) regarding polymerization shrinkage and contraction stresses and their ability to improve the shortcomings of the methacrylate-based resin composites (MRBC). Special attention is given to their physical and mechanical properties, bond strength, marginal adaptation, and cusp deflection. The clinical significance of this material is critically appraised with a focus on the ability of SBRC to strengthen the tooth structure as a direct restorative material. A search of English peer-reviewed dental literature (2003-2015) from PubMed and MEDLINE databases was conducted with the terms "low shrinkage" and "silorane composites." The list was screened, and 70 articles that were relevant to the objectives of this work were included.

Phosphoric and carboxylic methacrylate esters as bonding agents in self-adhesive resin cements

The aim of the present study was to investigate the effect of pH and phosphoric ester structure (phosphonate or phosphate) on the bond strength of different dental restorative materials. The following three self-adhesive resin cements were used in the present study: RelyX^™ Unicem, Maxcem and Multilink Sprint The pH of each cement was measured using a pH meter. The cements were used to attach a variety of restorative materials to human dentin and the bond strength was measured by assessing shear strength using a universal testing machine. The pH values of RelyX Unicem, Maxcem and Multilink Sprint were 3.78, 1.78 and 3.42, respectively. Maxcem, a phosphate-based self-adhesive cement, was demonstrated to form the weakest bonds. No significant difference in bond strength was observed between RelyX Unicem and Multilink Sprint, which are phosphonate-based cements. The results of the present study suggest that the chemical structure of the functional monomer influences the performance of an adhesive material. Furthermore, the pH of acidic functional monomers containing phosphonate or phosphate groups has an effect on the strength of bonds formed between dentin and restorative materials.

Polymerization shrinkage stress of resin-based dental materials: A systematic review and meta-analyses of composition strategies

PURPOSE

A systematic review was conducted to determine whether there were composition strategies available to reduce and control polymerization shrinkage stress development in resin-based restorative dental materials.

DATA SOURCES

This report was reported in accordance with the PRISMA Statement. Two reviewers performed a literature search up to December 2016, without restriction of the year of publication, in seven databases: PubMed, Web of Science, Scopus, SciELO, LILACS, IBECS, and BBO.

STUDY SELECTION

Only laboratory studies that evaluated polymerization shrinkage stress by direct testing were included. Pilot studies, reviews and in vitro studies that evaluated polymerization shrinkage stress by indirect methods (e.g., microleakage or cuspal deflection measurements), finite elemental analysis, or theoretical and mathematical models were excluded. Of the 6113 eligible articles, 62 studies were included in the qualitative analysis, and the meta-analysis was performed with 58 studies. The composition strategy was subdivided according to the modified part of the material: filler phase, coupling agent, or resin matrix. A global comparison was performed with random-effects models (α = 0.05). The only subgroup that did not show a statistical difference between the alternative strategy and the control was 'the use of alternative photo-initiators' (p = 0.29).

CONCLUSION

Modification of the resin matrix made the largest contribution to minimizing stress development. The technology used for decreasing stress in the formulation of low-shrinkage and bulk-fill materials was shown to be a promising application for reducing and controlling stress development.

Meta-analysis of the clinical behavior of posterior direct resin restorations: Low polymerization shrinkage resin in comparison to methacrylate composite resin

Polymerization shrinkage of resin composite can compromise the longevity of restorations. To minimize this problem, the monomeric composition of composites have been modified. The objective of this study was to conduct a meta-analysis to assess the clinical behavior of restorations performed with low polymerization shrinkage resin composite in comparison with traditional methacrylates-based resin composite. This systematic review was registered at Prospero data system (CRD42015023940). Studies were searched in the electronic databases PubMed, Web of Science, Scopus, Lilacs and EMBASE according to a predefined search strategy. The inclusion criteria were as follow: (1) randomized controlled clinical trials with at least six months of follow-up; (2) studies investigating composites with monomers designed to reduce polymerization shrinkage; (3) studies conducted with class I or II restorations in the permanent dentition; and (4) studies that assessed at least one of the following criteria: marginal integrity/adaptation, marginal discoloration, recurent caries, retention of composite restorations, and postoperative sensitivity. Two independent reviewers analyzed the articles to determine inclusion and risk of bias. The search conducted in the databases resulted in a total of 14,217 studies. After reviewing the references and citations, 21 articles remained. The longest clinical follow-up time was 60 months. The meta-analysis of the data in the included studies demonstrated that only one variable (marginal adaptation after 12 months) showed statistically significant outcomes, in which methacrylates-based composites presented significantly better results than resin composites containing modified monomers. The good level of the scientific evidence as well as the overall low risk of bias of the included studies indicate that composites with silorane, ormocer or bulk-fill type modified monomers have a clinical performance similar to conventional resin composites.

Polymerization Behavior and Mechanical Properties of High-Viscosity Bulk Fill and Low Shrinkage Resin Composites

The present study determined the mechanical properties and volumetric polymerization shrinkage of different categories of resin composite. Three high viscosity bulk fill resin composites were tested: Tetric EvoCeram Bulk Fill (TB, Ivoclar Vivadent), Filtek Bulk Fill posterior restorative (FB, 3M ESPE), and Sonic Fill (SF, Kerr Corp). Two low-shrinkage resin composites, Kalore (KL, GC Corp) and Filtek LS Posterior (LS, 3M ESPE), were used. Three conventional resin composites, Herculite Ultra (HU, Kerr Corp), Estelite ∑ Quick (EQ, Tokuyama Dental), and Filtek Supreme Ultra (SU, 3M ESPE), were used as comparison materials. Following ISO Specification 4049, six specimens for each resin composite were used to determine flexural strength, elastic modulus, and resilience. Volumetric polymerization shrinkage was determined using a water-filled dilatometer. Data were evaluated using analysis of variance followed by Tukey's honestly significant difference test (α=0.05). The flexural strength of the resin composites ranged from 115.4 to 148.1 MPa, the elastic modulus ranged from 5.6 to 13.4 GPa, and the resilience ranged from 0.70 to 1.0 MJ/m3. There were significant differences in flexural properties between the materials but no clear outliers. Volumetric changes as a function of time over a duration of 180 seconds depended on the type of resin composite. However, for all the resin composites, apart from LS, volumetric shrinkage began soon after the start of light irradiation, and a rapid decrease in volume during light irradiation followed by a slower decrease was observed. The low shrinkage resin composites KL and LS showed significantly lower volumetric shrinkage than the other tested materials at the measuring point of 180 seconds. In contrast, the three bulk fill resin composites showed higher volumetric change than the other resin composites. The findings from this study provide clinicians with valuable information regarding the mechanical properties and polymerization kinetics of these categories of current resin composite.

Polymer-Based Direct Filling Materials

After a brief review of current restorative materials and classifications, this article discusses the latest developments in polymer-based direct filling materials, with emphasis on products and studies available in the last 10 years. This will include the more recent bulk fill composites and self-adhesive materials, for which clinical evidence of success, albeit somewhat limited, is already available. The article also introduces the latest cutting edge research topics on new materials for composite restorations, and an outlook for the future of how those may help to improve the service life of dental composite restorations.

Efficiency of polymerization of bulk-fill composite resins: a systematic review

This systematic review assessed the literature to evaluate the efficiency of polymerization of bulk-fill composite resins at 4 mm restoration depth. PubMed, Cochrane, Scopus and Web of Science databases were searched with no restrictions on year, publication status, or article's language. Selection criteria included studies that evaluated bulk-fill composite resin when inserted in a minimum thickness of 4 mm, followed by curing according to the manufacturers' instructions; presented sound statistical data; and comparison with a control group and/or a reference measurement of quality of polymerization. The evidence level was evaluated by qualitative scoring system and classified as high-, moderate- and low- evidence level. A total of 534 articles were retrieved in the initial search. After the review process, only 10 full-text articles met the inclusion criteria. Most articles included (80%) were classified as high evidence level. Among several techniques, microhardness was the most frequently method performed by the studies included in this systematic review. Irrespective to the "in vitro" method performed, bulk fill RBCs were partially likely to fulfill the important requirement regarding properly curing in 4 mm of cavity depth measured by depth of cure and / or degree of conversion. In general, low viscosities BFCs performed better regarding polymerization efficiency compared to the high viscosities BFCs.

Delayed photo-activation and addition of thio-urethane: Impact on polymerization kinetics and stress of dual-cured resin cements

OBJECTIVE

1) to determine the moment during the redox polymerization reaction of dual cure cements at which to photo-activate the material in order to reduce the polymerization stress, and 2) to evaluate possible synergistic effects between adding chain transfer agents and delayed photo-activation.

METHODS

The two pastes of an experimental dual-cure material were mixed, and the polymerization kinetics of the redox phase was followed. The moment when the material reached its maximum rate of redox polymerization (MRRP) of cement was determined. The degree of conversion (DC) and maximum rates of polymerization (Rp_max) were assessed for materials where: the photoactivation immediately followed material mixing, at MRRP, 1min before and 1min after MRRP. Thio-urethane (TU) additives were synthesized and added to the cement (20% wt), which was then cured under the same conditions. The polymerization kinetics was evaluated for both cements photo-activated immediately or at MRRP, followed by measurements of polymerization stress, flexural strength (FS) and elastic modulus (EM). Knoop hardness was measured before and after ethanol storage.

RESULTS

Photo-activating the cement at or after MRRP reduced the Rp_max and the polymerization stress. Addition of TU promoted additional and more significant reduction, while not affecting the Rp_max. Greater hardness loss was observed for cements with TU, but the final hardness was similar for all experimental conditions. Addition of TU slightly reduced the EM and did not affect the FS.

CONCLUSION

Delayed photo-activation and addition of TU significantly reduce the polymerization stress of dual-cured cements.

Factors affecting marginal integrity of class II bulk-fill composite resin restorations

Background. Bulk-fill composite resins are a new type of resin-based composite resins, claimed to have the capacity to be placed in thick layers, up to 4 mm. This study was carried out to evaluate factors affecting gap formation in Cl II cavities restored using the bulk-fill technique.

Methods. A total of 60 third molars were used in this study. Two Cl II cavities were prepared in each tooth, one on the mesial aspect 1 mm coronal to the CEJ and one on the distal aspect 1 mm apical to the CEJ. The teeth were divided into 4 groups: A: The cavities were restored using the bulk-fill technique with Filtek P90 composite resin and its adhesive system and light-cured with quartz tungsten halogen (QTH) light-curing unit. B: The cavities were restored similar to that in group A but light-cured with an LED light-curing unit. C: The cavities were restored using the bulk-fill technique with X-tra Fil composite resin and Clearfil SE Bond adhesive system and light-cured with a QTH curing unit. D: The cavities were restored similar to that in group C but light-cured with an LED light-curing unit. The gaps were examined under a stereomicroscope at ×60. Data were analyzed with General Linear Model test. In cases of statistical significance (P<0.05), post hoc Bonferroni test was used for further analyses.

Results. The light-curing unit type had no effect on gap formation. However, the results were significant in relation to the composite resin type and margin location (P<0.001). The cumulative effects of light-curing unit*gingival margin and light-curing unit*composite resin type were not significant; however, the cumulative effect of composite rein type*gingival margin was significant (P=0.04)

Conclusion. X-tra Fil composite exhibited smaller gaps compared with Filtek P90 composite with both light-curing units. Both composite resins exhibited smaller gaps at enamel margins.

Effect of Insufficient Light Exposure on Polymerization Kinetics of Conventional and Self-adhesive Dual-cure Resin Cements

Objectives: The purpose of this study was to investigate the influence of insufficient light exposure on the polymerization of conventional and self-adhesive dual-cure resin cements under ceramic restorations.

Methods: Two conventional dual-cure resin cements (Rely-X ARC, Duolink) and two self-adhesive resin cements (Rely-X U200, Maxcem Elite) were polymerized under different curing modes (dual-cure or self-cure), curing times (20 and 120 seconds), and thickness of a ceramic overlay (2 and 4 mm). Polymerization kinetics was measured by Fourier transform infrared spectroscopy for the initial 10 minutes and after 24 hours. Data were analyzed using mixed model analysis of variance (ANOVA), one-way ANOVA/Student-Newman-Keuls post hoc test, and paired t-test (α=0.05).

Results: When light-curing time was set to 20 seconds, the presence of the ceramic block significantly affected the degree of conversion (DC) of all resin cements. Especially, the DC of the groups with 20 seconds of light-curing time under 4 mm of ceramic thickness was even lower than that of the self-cured groups at 24 hours after polymerization (p&lt;0.05). However, when light-curing time was set to 120 seconds, a similar DC compared with the group with direct light exposure (p&gt;0.05) was achieved in all dual-cure groups except Maxcem Elite, at 24 hours after polymerization.

Conclusions: For both conventional and self-adhesive dual-cure resin cements, insufficient light exposure (20 seconds of light-curing time) through thick ceramic restoration (4 mm thick) resulted in a DC even lower than that of self-curing alone.

Polymerization stress evolution of a bulk-fill flowable composite under different compliances

OBJECTIVE

To use a compliance-variable instrument to simultaneously measure and compare the polymerization stress (PS) evolution, degree of conversion (DC), and exotherm of a bulk-fill flowable composite to a packable composite.

METHODS

A bulk-fill flowable composite (Filtek Bulk-fill, FBF) and a conventional packable composite (Filtek Z250, Z250) purchased from 3M ESPE were investigated. The composites were studied using a cantilever-beam based instrument equipped with an in situ near infrared (NIR) spectrometer and a microprobe thermocouple. The measurements were carried out under various instrumental compliances (ranging from 0.3327μm/N to 12.3215μm/N) that are comparable to the compliances of clinically prepared tooth cavities. Correlations between the PS and temperature change as well as the DC were interpreted.

RESULTS

The maximum PS of both composites at 10min after irradiation decreased with the increase in the compliance of the cantilever beam. The FBF composite generated a lower final stress than the Z250 sample under instrumental compliances less than ca. 4μm/N; however, both materials generated statistically similar PS values at higher compliances. The reaction exotherm and the DC of both materials were found to be independent of compliance. The DC of the FBF sample was slightly higher than that of the packable Z250 composite while the peak exotherm of FBF was almost double that of the Z250 composite. For FBF, a characteristic drop in the PS was observed during the early stage of polymerization for all compliances studied which was not observed in the Z250 sample. This drop was shown to relate to the greater exotherm of the less-filled FBF sample relative to the Z250 composite.

SIGNIFICANCE

While the composites with lower filler content (low viscosity) are generally considered to have lower PS than the conventional packable composites, a bulk-fill flowable composite was shown to produce lower PS under a lower compliance of constraint as would be experienced if the composite was used as the base material in clinical procedures.

ZnO–AlBw-reinforced dental resin composites: the effect of pH level on mechanical properties

Silanized ZnO–AlBws were synthesized and manually mixed by spatulation with a dental resin monomer consisting of UDMA, TEGDMA, CQ and DMAEMA. The paste was placed into a steel mold, and the specimens were cured by light at atmospheric pressure to make flexural specimens.

Effect of 457 nm diode-pumped solid state laser on the polymerization composite resins: microhardness, cross-link density, and polymerization shrinkage

OBJECTIVE

The purpose of the present study was to test the usefulness of 457 nm diode-pumped solid state (DPSS) laser as a light source to cure composite resins.

MATERIALS AND METHODS

Five different composite resins were light cured using three different light-curing units (LCUs): a DPSS 457 nm laser (LAS), a light-emitting diode (LED), and quartz-tungsten-halogen (QTH) units. The light intensity of LAS was 560 mW/cm(2), whereas LED and QTH LCUs was ∼900 mW/cm(2). The degree of polymerization was tested by evaluating microhardness, cross-link density, and polymerization shrinkage.

RESULTS

Before water immersion, the microhardness of laser-treated specimens ranged from 40.8 to 84.7 HV and from 31.7 to 79.0 HV on the top and bottom surfaces, respectively, and these values were 3.3-23.2% and 2.9-31.1% lower than the highest microhardness obtained using LED or QTH LCUs. Also, laser-treated specimens had lower top and bottom microhardnesses than the other LCUs treated specimens by 2.4-19.4% and 1.4-27.8%, respectively. After ethanol immersion for 24 h, the microhardness of laser-treated specimens ranged from 20.3 to 63.2 HV on top and bottom surfaces, but from 24.9 to 71.5 HV when specimens were cured using the other LCUs. Polymerization shrinkage was 9.8-14.7 μm for laser-treated specimens, and these were significantly similar or lower (10.2-16.0 μm) than those obtained using the other LCUs.

CONCLUSIONS

The results may suggest that the 457 nm DPSS laser can be used as a light source for light-curing dental resin composites.

Simultaneous measurement of polymerization stress and curing kinetics for photo-polymerized composites with high filler contents

OBJECTIVES

Photopolymerized composites are used in a broad range of applications with their performance largely directed by reaction kinetics and contraction accompanying polymerization. The present study was to demonstrate an instrument capable of simultaneously collecting multiple kinetics parameters for a wide range of photopolymerizable systems: degree of conversion (DC), reaction exotherm, and polymerization stress (PS).

METHODS

Our system consisted of a cantilever beam-based instrument (tensometer) that has been optimized to capture a large range of stress generated by lightly-filled to highly-filled composites. The sample configuration allows the tensometer to be coupled to a fast near infrared (NIR) spectrometer collecting spectra in transmission mode.

RESULTS

Using our instrument design, simultaneous measurements of PS and DC are performed, for the first time, on a commercial composite with ≈80% (by mass) silica particle fillers. The in situ NIR spectrometer collects more than 10 spectra per second, allowing for thorough characterization of reaction kinetics. With increased instrument sensitivity coupled with the ability to collect real time reaction kinetics information, we show that the external constraint imposed by the cantilever beam during polymerization could affect the rate of cure and final degree of polymerization.

SIGNIFICANCE

The present simultaneous measurement technique is expected to provide new insights into kinetics and property relationships for photopolymerized composites with high filler content such as dental restorative composites.

Temperature-dependent polymerization shrinkage stress kinetics of resin-composites

OBJECTIVES

To determine temperature dependence of shrinkage stress kinetics for a set of resin composites formulated with dimethacrylate monomer matrices.

METHODS

Six representative resin composites with a range of resin matrices were selected. Two of them were considered as low shrinking resin composites: Kalore and Venus Diamond. The shrinkage stress kinetics at 23°C and 37°C were measured continuously using a Bioman instrument for 60min. Stress levels between materials were compared at two intervals: 2min and 60min. Specimen temperatures were controlled by a newly designed heating device. Stress measurements were monitored for 1h, after irradiation for 40s at 550mW/cm(2) (energy density=22J/cm(2)). Three specimens (n=3) were used at each temperature per material.

RESULTS

Shrinkage stress at 23°C ranged from 2.93MPa to 4.71MPa and from 3.57MPa to 5.42MPa for 2min and 60min after photo-activation, respectively. The lowest stress-rates were recorded for Kalore and Venus Diamond (0.34MPas(-1)), whereas the highest was recorded for Filtek Supreme XTE (0.63MPas(-1)). At 37°C, shrinkage stress ranged from 3.27MPa to 5.35MPa and from 3.36MPa to 5.49MPa for 2min and 60min after photo-activation, respectively. Kalore had the lowest stress-rate (0.44MPas(-1)), whereas Filtek Supreme XTE had the highest (0.85MPas(-1)). Materials exhibited a higher stress at 37°C than 23°C except for Kalore and Venus Diamond. Positive correlations were found between shrinkage stress and stress-rate at 23°C and 37°C (r=0.70 and 0.92, respectively).

SIGNIFICANCE

Resin-composites polymerized at elevated temperature (37°C) completed stress build up more rapidly than specimens held at 23°C. Two composites exhibited atypical reduced stress magnitudes at the higher temperature.

Characterization of a low shrinkage dental composite containing bismethylene spiroorthocarbonate expanding monomer

In this study, a novel dental composite based on the unsaturated bismethylene spiroorthocarbonate expanding monomer 3,9-dimethylene-1,3,5,7-tetraoxa-spiro[5,5]undecane (BMSOC) and bisphenol-S-bis(3-meth acrylate-2-hydroxypropyl)ether (BisS-GMA) was prepared. CQ (camphorquinone) of 1 wt % and DMAEMA (2-(dimethylamino)ethyl methacrylate) of 2 wt % were used in a photoinitiation system to initiate the copolymerization of the matrix resins. Distilled water contact angle measurements were performed for the wettability measurement. Degree of conversion, volumetric shrinkage, contraction stress and compressive strength were measured using Fourier Transformation Infrared-FTIR spectroscopy, the AccuVol and a universal testing machine, respectively. Within the limitations of this study, it can be concluded that the resin composites modified by bismethylene spiroorthocarbonate and BisS-GMA showed a low volumetric shrinkage at 1.25% and a higher contact angle. The lower contraction stress, higher degree of conversion and compressive strength of the novel dental composites were also observed.