Elution of monomer from different bulk fill dental composite resins

Evaluation of the Impact of Irradiance Lamps and Storage Media on Elution of TEGDMA from Dental Composites

OBJECTIVES

 The aim of this study was to evaluate and compare the effect of irradiance light and storage media on the elution of triethylene glycol dimethacrylate (TEGDMA) from conventional Filtek Z350XT 3M ESPE and two bulk-fill composites Shofu Beautifil-Bulk and Filtek Bulk fill flowable 3M ESPE using high-performance liquid chromatography (HPLC).

MATERIALS AND METHODS

 Shofu Beautifil-Bulk, Filtek Bulk fill flowable 3M ESPE, and Filtek Z350XT 3M ESPE were the three types of composites used in this study. Disk shaped samples of 4-mm thickness and 10-mm diameter were fabricated using a stainless steel mold and were polymerized using light emitting diode (LED) and quartz tungsten halogen (QTH) lamps. After polymerization, the samples were immersed in ethanol, artificial saliva with betel quid extract, and distilled water for 1, 7, and 30 days, respectively. The elution of monomer TEGDMA was evaluated using HPLC.

STATISTICAL ANALYSIS

 To evaluate the mean concentration difference, mixed way analysis of variance (ANOVA) was applied. Between different light, materials, and within the time duration, Tukey's post hoc test was used. A p value of 0.05 was considered significant.

RESULTS

 During the first day of storage, a significant amount of monomer TEGDMA elution was seen in all the materials. The highest values observed to be in the disks cured with QTH lamp. However, the highest elution was seen when the disks were immersed in ethanol/water solution. While the most stable medium was distilled water, artificial saliva with betel nut extract also had a significant effect on the elution of TEGDMA. The highest value obtained was of Filtek Bulk fill flowable 3M ESPE after 30 days of immersion in both LED and QTH cured disks.

CONCLUSION

 Filtek Bulk fill flowable 3M ESPE shows better properties in relation to the release of monomer TEGDMA as it releases less amount of monomer in the storage media. The release of monomer was highest in ethanol as compared to artificial saliva and distilled water with the passage of time.

Elution from direct composites for provisional restorations

Purpose To assess elution from direct composite materials for provisional restorations and compare them with elution from direct restorative composites for permanent restorations.Methods Two dual-cure (Integrity Multi-Cure and Tempsmart DC) and two self-curing composites (Protemp 4 and Structur 3) were used, with Essentia serving as a reference. Cylindrical specimens (n=20) were cured according to the manufacturer's instructions; the dual-cure materials were prepared in both self- and dual-curing modes. Elution experiments were performed using water and absolute ethanol. The samples were incubated at 37 °C for either 24 h or four weeks; the extraction solvents were refreshed weekly. The eluted BisEMA (-3 / -6 / -10), BisGMA, CQ, UDMA, and TEGDMA were quantified using UHPLC-MS/MS.Results Monomer elution was detected in all provisional composites at 24 h and four weeks, but the amounts released did not exceed those released by the reference composite. When prepared in self-curing mode, Integrity Multi-Cure exhibited significantly higher elution of BisEMA-3, -6, and -10 in ethanol both after 24 h and cumulatively after four weeks. Self-cured Tempsmart DC released significantly more CQ, TEGDMA, and UDMA in both water and ethanol after immersion for 24 h and four weeks, along with significantly more BisGMA in ethanol both after 24 h and four weeks comparison to dual-cured Tempsmart DC (two-way ANOVA, post-hoc Tukey, P < 0.05).Conclusions Provisional composite materials did not elute higher amounts of monomers than a restorative composite. Dual-cured materials, prepared in the self-curing mode, show a trend towards higher monomer elution.

Effects of ceramic thickness, ceramic translucency, and light transmission on light-cured bulk-fill resin composites as luting cement of lithium disilicate based-ceramics

PURPOSE

To assess the effects of ceramic thickness, ceramic translucency, and light transmission on restorative composites used as luting cement for lithium disilicate-based ceramics.

METHODS

Four luting types of cement were tested (n=8); a dual-cured resin cement (Multilink N), a light-cured conventional flowable composite (Tetric N-Flow), and two light-cured bulk-fill flowable composites (Tetric N-Flow Bulk Fill and X-tra base). The 20 s- or 40 s-light (1000 mW/cm2) was transmitted through 1- or 2-mm-thick high- or low-translucency (HT- or LT-) ceramic discs (IPS e.Max press) to reach the 1-mm-thick luting cement. Light transmitted to cement without ceramic served as a control. Vickers hardness number (VHN), flexural strength (FS), fractography, and degree of conversion (DC) were evaluated. One-way and multi-way analysis of variance was conducted to determine the effects of factors on VHN and FS.

RESULTS

Ceramic thickness, light transmission time, and cement type significantly affected the VHN of the luting cement (P < .000). Only Multilink N (LT- and HT-1mm) and Tetric N-Flow (HT-1mm) reached 90% VHN of corresponding control by 20 s-light transmissions, but Tetric N-Flow exhibited lowest VHN and approximately 1/3-1/2 VHN of Multilink N (P < 0.05). X-tra base expressed superior physicochemical properties to Tetric N-Flow Bulk Fill (P < 0.05) and reached >90% VHN of control in all conditions with 40 s-light transmissions except for LT-2 mm. DC, FS, and fractography supported these findings.

CONCLUSIONS

The light-cured bulk-fill composite served as a luting cement for lithium-disilicate-based ceramics in a product-dependent manner. Light transmission time is crucial to ensure sufficient luting cement polymerization.

Characterisation of experimental flowable composites containing fluoride-doped calcium phosphates as promising remineralising materials

OBJECTIVE

Remineralising composites with antibacterial properties may seal the cavity and prevent secondary caries. This study aimed at developing experimental flowable composites containing different concentrations of fluoride-doped calcium phosphate fillers and evaluating their remineralising and antibacterial properties.

METHODS

Experimental resin-based composites containing different concentrations (0-20 %) of fluoride-doped calcium phosphate fillers (VS10/VS20) were formulated. The release of calcium (Ca), phosphate (PO) and fluoride (F) ions was assessed for 30 days. Remineralisation properties were evaluated through ATR-FTIR and SEM/EDX after storage in simulated body fluid (SBF). The metabolic activity and viability of Streptococcus gordonii was also evaluated through ATP, CFU and live/dead confocal microscopy. The evaluation of specific monomer elution from the experimental composites was conducted using high-performance liquid chromatography (HPLC).

RESULTS

The composites containing VS10 showed the highest release of Ca, those containing VS20 released more F over time (p < 0.05), while there was no significant difference in terms of PO ions release between the groups (p > 0.05). A quick 7-day mineral precipitation was observed in the tested composites containing VS10 or VS20 at 10 %; these materials also showed the greatest antibacterial activity (p < 0.05). Moreover, the tested composites containing VS10 presented the lowest elution of monomers (p < 0.05).

CONCLUSIONS

Innovative composites were developed with low monomers elution, evident antibacterial activity against S. gordonii and important remineralisation properties due to specific ions release.

CLINICAL SIGNIFICANCE

Novel composites containing fluoride-doped calcium phosphates may be promising to modulate bacteria growth, promote remineralisation and reduce the risk of cytotoxicity related to monomers' elution.

Effects of three disinfection solutions on residual monomers released from resin nanoceramic CAD/CAM blocks

The aim of this study was to evaluate the effects of three disinfection solutions on the amount of monomers released from resin nanoceramic CAD/CAM blocks using high performance liquid chromatography (HPLC). Forty resin nanoceramic CAD/CAM (Cerasmart, GC, Japan) samples (12x14 × 2 mm) were divided into four groups; each group was disinfected using one of four solutions (Group 1: no disinfectant; Group 2: 70 % ethanol; Group 3: 2 % glutaraldehyde; and Group 4: 1 % sodium hypochlorite) for 5 min. Analysis of residual monomers (UDMA and Bis-EMA) amounts was performed using an HPLC instrument (Dionex Ultimate 3000, Thermo Fisher Scientific). After 30 days, the amounts of monomers found were as follows: 14.54 ppm for Group 1; 9.28 ppm for Group 2; 10.60 ppm for Group 3; and 2.76 ppm for Group 4 (the smallest monomer amount) (p < 0.001). Disinfection of indirect restorations prior to cementation can reduce the amount of residual monomers remaining from resin nanoceramic CAD/CAM blocks.

Evaluation of the amount of residual monomer released from different flowable composite resins

Today, resin materials are used in the restoration of permanent and deciduous teeth or as fissure sealants. The materials can contain different types of monomers (Bis-GMA, UDMA, TEGDMA). These monomers can be released into the oral cavity after polymerization. Residual monomers released from resin-containing restorative materials after polymerization have been reported to have negative effects on mechanical properties. The aim of our study is to evaluate the amount of residual monomers released after polymerization of different flowable composite resin materials using two different modes of LED light source. Composite disc samples (8 mm diameter/2 mm depth) prepared for each material group were polymerized using two different modes of the LED light device (Standard mode and extra power mode). HPLC (High Performance Liquid Chromatography) device was used to measure the amount of residual monomer release at 1 h, 1 day, 3 days and 7 days periods. Pairwise comparison of the differences between the materials was performed by Post-hoc test. For each residual monomer, the Kruskal Wallis test was used to analyze the difference between the materials in standard mode and the difference between the materials in extra power mode. According to the results of the study; Grandio flow flowable composite showed the highest release of TEGDMA and Bis-GMA while SDR® Flow flowable composite showed the lowest release of TEGDMA, Bis-GMA and UDMA. For all materials, the extra power mode resulted in more residual monomer release. TEGDMA and Bis-GMA release was detected in all tested flowable composites at all time periods.

Degradation products of resin-based materials detected in saliva in vivo

OBJECTIVES

Dental composites remain under scrutiny regarding their (long-term) safety. In spite of numerous studies on the release of monomers both in vitro and in vivo, only limited quantitative data exist on the in vivo leaching of degradation products from monomers and additives. The aim of this observational study was for the first time to quantitatively and qualitatively monitor the release of parent compounds and their degradation products in saliva from patients undergoing multiple restorations.

MATERIALS AND METHODS

Five patients in need of multiple large composite restorations (minimally 5 up to 28 restorations) due to wear (attrition, abrasion, and erosion) were included in the study, and they received adhesive restorative treatment according to the standard procedures in the university clinic for Restorative Dentistry. Saliva was collected at different time points, starting before the restoration up until 24 h after the treatment with composite restorations. Saliva extracts were analyzed by liquid chromatography-mass spectrometry.

RESULTS

Leaching of monomers and degradation products was highest within 30 min after the placement of the restorations. The highest median concentrations of monomers were recorded for UDMA, BisEMA-3, and TEGDMA; yet, besides BisEMA-3 and TEGDMA, no monomers could be detected after 24 h. Mono- and demethacrylated degradation products remained present up to 24 h and concentrations were generally higher than those of monomers. In patients with multiple restorations, degradation products were still present in the sample taken before the next operation, several weeks after the previous operation.

CONCLUSIONS

Exposure to residual monomers and degradation products occurs in the first hours after restoration. Monomers are present in saliva shortly after restoration, but degradation products can be detected weeks after the restoration confirming a long-term release.

CLINICAL SIGNIFICANCE

Future research should focus more on the release of degradation products from monomers and additives from resin-based materials given their prolonged presence in saliva after restoration.

Unlocking the potential of 3D printed microfluidics for mass spectrometry analysis using liquid infused surfaces

Combining microfluidics with mass spectrometry (MS) analysis has great potential for enabling new analytical applications and simplifying existing MS workflows. The rapid development of 3D printing technology has enabled direct fabrication of microfluidic channels using consumer grade 3D printers, which holds great promise to facilitate the adoption of microfluidic devices by the MS community. However, photo polymerization-based 3D printed devices have an issue with chemical leeching, which can introduce contaminant molecules that may present as isobaric ions and/or severely suppress the ionization of target analytes when combined with MS analysis. Although extra cure and washing steps have alleviated the leeching issue, many such contaminant peaks can still show up in mass spectra. In this work, we report a simple surface modification strategy to isolate the chemical leachates from the channel solution thereby eliminating the contaminant peaks for MS analysis. The channel was prepared by fabricating a layer of polydimethylsiloxane graft followed by wetting the graft using silicone oil. The resulting liquid infused surface (LIS) showed significant reduction in contaminant peaks and improvement in the signal intensity of target analytes. The coating showed good stability after long-term usage (7 days) and long-term storage (∼6 months). Finally, the utility of the coating strategy was demonstrated by printing herringbone microfluidic mixers for studying fast reaction kinetics, which obtained comparable reaction rates to literature values. The effectiveness, simplicity, and stability of the present method will promote the adoption of 3D printed microdevices by the MS community.

Release Kinetics of Monomers from Dental Composites Containing Fluoride-Doped Calcium Phosphates

This study analyse the type of release kinetic of specific monomers from dental resin composites containing various fluoride-doped calcium phosphates. The release behavior of urethane dimethacrylate (UDMA), ethoxylated bisphenol-A dimethacrylate (bis-EMA) and 1.6-hexanediol ethoxylate diacrylate (HEDA) was evaluated over a period of 35 days. Two tailored calcium phosphates doped with different concentrations of fluoride salts (VS10% and VS20%) were prepared and incorporated in the dimethacrylate matrix at various concentrations to generate a range of experimental composites. The release kinetics were characterized using mathematical models such as zero-order, first-order, Peppas and Higuchi models. The results showed that the first-order model best described the release kinetics. UDMA and HEDA exhibited significant differences in release compared to bis-EMA from day 1, while no significant differences were observed between UDMA and HEDA, except on day 35, when UDMA exhibited a higher release rate than HEDA. When comparing the release of each monomer, VS20-R20% had the highest total release percentage, with 3.10 ± 0.25%, whereas the composite VS10-R5% showed the lowest release percentage, with a total of 1.66 ± 0.08%. The release kinetics were influenced by the composition of the resin composites and the presence of calcium fluoride and sodium fluoride in the calcium phosphate played a role in the maximum amounts of monomer released. In conclusion, the release of monomers from the tested resin composites followed a first-order kinetic behaviour, with an initial rapid release that decreased over time. The composition of the resin monomers and the presence of fluoride salts influenced the release kinetics. The VS10-R5% and VS10-R10% resin composites exhibited the lowest total monomer release, suggesting its potential favourable composition with reduced monomer elution. These findings contribute to understanding the release behavior of dental resin composites and provide insights for the development of resin-based bioactive dental materials.

Release of Monomers from Dental Composite Materials into Saliva and the Possibility of Reducing the Toxic Risk for the Patient

Background and Objectives: The objective of this study was (1) to measure the amount of monomers released into the saliva depending on the time elapsed after the hardening of the composite and on the type of monomer used; and (2) with the prolongation of the light-curing procedure, to publish information on whether it would be possible to influence the level of leached monomers. Materials and Methods: HPLC technique was used to monitor the levels of the unpolymerized monomers Bis-GMA, Bis/EMA, TEGDMA, and UDMA from the four commonly used composite materials, released into the saliva of a volunteer with intact dentition. The levels were monitored in 3 time periods during 24 h after composite hardening. From every composite material, 4 samples were formed and cured with an LED lamp for 10 s, 20 s, 40 s, and 60 s. After the light curing, the same polishing procedure was used and the samples were leached in blank saliva samples. Results: We observed that every monitored composite material eluted monomers into the saliva after its application. The amount of monomers depended on the time elapsed after the curing of the composite and on the type of composite used. A 40 s LED curing procedure can reduce the amount of leached monomers in comparison with the standard 20 s procedure, especially for monomers of higher molecular weight. Conclusions: Our study confirmed the hypothesis that the release of monomers gradually decreases with increasing time after the hardening of the composite filling.

Degree of conversion and residual monomer elution of 3D-printed, milled and self-cured resin-based composite materials for temporary dental crowns and bridges

The aim of this work was to investigate the elution of residual monomers as a function of the manufacturing process, which are CAD/CAM manufacturing, self-curing and 3D printing. The experimental materials used consisted of the base monomers TEGDMA, Bis-GMA and Bis-EMA and 50 wt.% fillers. Additionally, a 3D printing resin without fillers was tested. The elution of the base monomers into the different media (water, ethanol and ethanol/water (75/25 vol. %)) at 37 °C over a period of up to 120 d as well as the degree of conversion (DC) by FTIR were investigated. No monomer elution could be detected in water. Most residual monomers in both other media were released from the self-curing material whereas the 3D printing composite released relatively little. The CAD/CAM blanks released hardly any quantitatively detectable amounts of monomers. Relative to the base composition, TEGDMA eluted less than Bis-GMA and Bis-EMA. DC did not correlate with residual monomer release; thus, leaching was determined not only by the amount of residual monomers present but by further factors as possibly network density and structure. The CAD/CAM blanks and the 3D printing composite showed similar high DC but lower residual monomer release from the CAD/CAM blank, likewise the self-curing composite and the 3D printing resin exhibited similar DC but different monomer elution. In terms of residual monomer elution and DC, the 3D printing composite seems promising as a new material class for the use as temporary dental crowns and bridges.

The effect of high-irradiance rapid polymerization on degree of conversion, monomer elution, polymerization shrinkage and porosity of bulk-fill resin composites

OBJECTIVE

The purpose was to compare the degree of conversion (DC), monomer elution (ME), polymerization shrinkage (PS) and porosity of two addition-fragmentation chain transfer (AFCT) modified resin-based composites (RBC) light-cured with rapid- (RP), turbo- (TP) or conventional polymerization (CP) settings.

METHODS

Cylindrical samples (6-mm wide, 4-mm thick) were prepared from Tetric PowerFill (TPF) and Filtek One Bulk (FOB). Four groups were established according to the polymerization settings: 3s-RP, 5s-TP, 10s-CP and 20s-CP. Samples in 1 mm thickness with 20s-CP settings served as controls. The DC at the top and bottom surfaces was measured with micro-Raman spectroscopy. ME was detected with high-performance liquid chromatography. PS and porosity were analyzed by micro-computed tomography. ANOVA and Tukey's post-hoc test, multivariate analysis and partial eta-squared statistics were used to analyze the data (p < 0.05).

RESULTS

FOB showed higher DC values (61.5-77.5 %) at the top compared to TPF (43.5-67.8 %). At the bottom TPF samples achieved higher DCs (39.9-58.5 %) than FOB (18.21-66.18 %). Extending the curing time increased DC (except the top of FOB) and decreased ME. BisGMA release was the highest among the detected monomers from both RBCs. The amount was three-fold more from TPF. The factor Material and Exposure significantly influenced DC and ME. PS (1.8-2.5 %) did not differ among the groups and RBCs except for the lowest value of TPF cured with the 3s_RP setting (p = 0.03). FOB showed 4.5-fold lower porosity (p < 0.001). Significantly higher pore volume was detected after polymerization in 3s_RP (p < 0.001).

SIGNIFICANCE

High-irradiance rapid 3-s curing of AFCT modified RBCs resulted in inferior results for some important material properties. A longer exposure time is recommended in a clinical situation.

Cytotoxicity and reactive oxygen species production induced by different co-monomer eluted from nanohybrid dental composites

BACKGROUND

Safety issues for dental restorative composites are critical to material selection, but, limited information is available to dental practitioners. This study aimed to compare the chemical and biological characteristics of three nanohybrid dental composites by assessing filler particle analysis, monomer degree of conversion (DC), the composition of eluates, and cytotoxicity and reactive oxygen species (ROS) production in fibroblasts.

METHODS

Three nanohybrid composites (TN, Tetric N-Ceram; CX, Ceram X Sphere Tec One; and DN, DenFil NX) were used. The size distribution and morphology of the filler particles were analysed using scanning electron microscopy (n = 5). The DC was measured via micro-Raman spectroscopy (n = 5). For the component analysis, methanol eluates from the light-polymerised composites were evaluated by gas chromatography/mass spectrometry (n = 3). The eluates were prepared from the polymerised composites after 24 h in a cell culture medium. A live/dead assay (n = 9) and Water-Soluble Tetrazolium-1 assay (n = 9) were performed and compared with negative and positive controls. The ROS in composites were compared with NC. Statistical significance in differences was assessed using a t-test and ANOVA (α = 0.05).

RESULTS

Morphological variations in different-sized fillers were observed in the composites. The DC values were not significantly different among the composites. The amounts of 2-hydroxyethyl methacrylate (HEMA) were higher in TN than DN (p = 0.0022) and triethylene glycol dimethacrylate (TEGDMA) in CX was higher than in others (p < 0.0001). The lowest cell viability was shown in CX (p < 0.0001) and the highest ROS formation was detected in TN (p < 0.0001).

CONCLUSIONS

Three nanohybrid dental composites exhibited various compositions of filler sizes and resin components, resulting in different levels of cytotoxicity and ROS production. Chemical compositions of dental composites can be considered with their biological impact on safety issues in the intraoral use of dental restorative composites. CX with the highest TEGDMA showed the highest cytotoxicity induced by ROS accumulation. DN with lower TEGDMA and HEMA presented the highest cell viability.

Detection of Leachable Components from Conventional and Dental Bulk-Fill Resin Composites (High and Low Viscosity) Using Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) Method

The aim of this study was to investigate leachable components (monomers) in high and low viscosity dental bulk-fill resin composites and conventional resin composite materials after polymerization. Six bulk-fill and six conventional dental resin composite materials were used in this study. The samples of each material (three sets of triplicates) were cured for 20 s with irradiance of 1200 mW/cm² with a LED curing unit and immersed in a 75% ethanol solution at 37 °C. The eluates from each triplicate set were analyzed after 24 h, 7 days or 28 days using liquid chromatography coupled with triple quadrupole tandem mass spectrometry (LC-MS/MS). Detectable amounts of 2-Hydroxyethyl methacrylate (HEMA) were found in both Gradia materials and the amount observed across different time points was statistically different (p ˂ 0.05), with the amount in solution increasing for Gradia and decreasing for Gradia Direct flo. Bisphenol A diglycidildimethacrylate (BIS GMA) was found in Filtek and Tetric materials. Triethylene glycol dimethacrylate (TEGDMA) was detected in all materials. On the other hand, there were no statistically significant differences in the amounts of TEGDMA detected across different time points in either of the tested materials. Monomers HEMA, TEGDMA, 4-dimethylaminobenzoic acid ethyl ester (DMA BEE) and BIS GMA in bulk-fill and conventional composites (high and low viscosity) can be eluted after polymerization. The good selection of composite material and proper handling, the following of the manufacturer's instructions for polymerization and the use of finishing and polishing procedures may reduce the elution of the unpolymerized monomers> responsible for the possible allergic and genotoxic potential of dental resin composites.

Effect of topical fluoride applications on residual monomer release from resin-based restorative materials

BACKGROUND

The effects of topical fluoride applications on the release of monomer ingredients from resin-based dental materials by immersion in various extraction solutions are unclear. The aim of this study was to determine the effect of topical fluorides (APF and NaF) on the elution of residual monomers (Bis-GMA, TEGDMA, UDMA, and HEMA) from resin-based materials.

METHODS

Ninety specimens were prepared, 30 bulk-fill composite resin, 30 nanohybrid universal composite resin, and 30 polyacid-modified composite resin (compomer). These were randomly divided into three groups based on fluoride application procedures. Each specimen was kept in 75% ethanol solution, and residual monomers released from materials were analyzed using high-performance liquid chromatography (HPLC) after 10 min, 1 h, 24 h, and 30 days. The groups were compared using the Mann Whitney U and Kruskal Wallis tests. Measurements were analyzed using the Friedman and Wilcoxon signed-rank tests.

RESULTS

Fluoride applications generally had no considerable effect on the amount of residual monomer released from resin-based restorative materials. The amount of monomer release after topical APF application was similar to the release in the control group and was lower than the release in the NaF group. The release of monomers from the resin-based material used in the study did not approach toxic levels at the applied time intervals. The compomer released lower amounts of monomer than other resin-based materials.

CONCLUSIONS

Fluoride applications do not increase monomer release from resin-based restorative materials. However, compomers should be employed by clinicians due to their lower monomer release compared to other resin restorative materials. The release of monomers from all the resin-based materials did not approach toxic levels at the applied time intervals.

Cytotoxic Evaluation of the New Composite Resin through an Artificial Pulp Chamber

The aim of this study was to analyse the cytocompatibility of Surefil One (SuO) with respect to the release of monomers from the material. The following reference materials were chosen: SDR Flow Plus (SDR, Dentsply Sirona, Konstanz, Germany), One Q Bond (Q, Dentalica, Milan, Italy), and Ketac (K, 3M-ESPE, USA). Fifteen dentin discs (2 mm thickness and diameter) were obtained from 15 third molars and were used in this study. After dentin disc permeability measurement, murine fibroblasts were grown, and the pulp surface of the dentinal disc was placed in direct contact with the cells immersed in DMEM. The experimental materials were positioned on the occlusal side of each dentinal disc until a uniform thickness of 2 mm was obtained. Then, the discs were inserted into an artificial pulp chamber for 24 hours to assess the cytocompatibility. Afterwards, the moles of monomers leached from the specimens in DMEM were determined using HPLC. Statistical analysis was performed using ANOVA (p < 0.05). Under the experimental conditions, the toxic effect induced by all tested materials was slight or absent. Diurethane dimethacrylate and acrylic acid were not found in the culture media. It is concluded that all materials have good cytocompatibility consistent with the nondeterminability of the monomers released after polymerization.

Analysis of Monomer Release from Different Composite Resins after Bleaching by HPLC

(1) Background: This study aimed to examine the effect of bleaching agents on the release of triethylenae glycol dimethacrylate, 2-hydroxyethyl methacrylate, bisphenol A, urethane dimethacrylate, and bisphenol A-glycidyl methacrylate monomers, which are released from different composite resins, using the high-performance liquid chromatography (HPLC) method. (2) Methods: Ninety disc-shaped specimens were produced and immersed in artificial saliva. After different bleaching applications [office type bleaching (OB) and home type bleaching (HB)], the specimens were immersed in a 75 wt% ethanol/water solution, and the released monomers were analyzed by HPLC at predefined time intervals: 1, 7, and 28 days. The Kruskal−Wallis and Mann−Whitney U tests were conducted for statistical analysis (p = 0.05). (3) Results: The monomers were released at all times from all composite specimens. The monomer release was increased over time. The highest monomer release was detected on day 28. Bleaching applications affected monomer release. No statistical difference was found between OB and HB applications (p > 0.05). The most released monomer was Bisphenol-A in all composites. (4) Conclusion: Given that a residual monomer release from composite resins has a toxic effect and that bleaching treatments increase this release, a treatment protocol should be made in accordance with the manufacturer’s instructions.

Monomer Release from Dental Resins: The Current Status on Study Setup, Detection and Quantification for In Vitro Testing

Improvements in mechanical properties and a shift of focus towards esthetic dentistry led to the application of dental resins in various areas of dentistry. However, dental resins are not inert in the oral environment and may release monomers and other substances such as Bisphenol-A (BPA) due to incomplete polymerization and intraoral degradation. Current research shows that various monomers present cytotoxic, genotoxic, proinflammatory, and even mutagenic effects. Of these eluting substances, the elution of BPA in the oral environment is of particular interest due to its role as an endocrine disruptor. For this reason, the release of residual monomers and especially BPA from dental resins has been a cause for public concern. The assessment of patient exposure and potential health risks of dental monomers require a reliable experimental and analytical setup. However, the heterogeneous study design applied in current research hinders biocompatibility testing by impeding comparative analysis of different studies and transfer to the clinical situation. Therefore, this review aims to provide information on each step of a robust experimental and analytical in vitro setup that allows the collection of clinically relevant data and future meta-analytical evaluations.

Prosthetic Materials Used for Implant-Supported Restorations and Their Biochemical Oral Interactions: A Narrative Review

The purpose of this study is to outline relevant elements regarding the biochemical interactions between prosthetic materials used for obtaining implant-supported restorations and the oral environment. Implant-supported prostheses have seen unprecedented development in recent years, benefiting from the emergence of both new prosthetic materials (with increased biocompatibility and very good mechanical behavior), and computerized manufacturing technologies, which offer predictability, accuracy, and reproducibility. On the other hand, the quality of conventional materials for obtaining implant-supported prostheses is acknowledged, as they have already proven their clinical performance. The properties of PMMA (poly (methyl methacrylate))-which is a representative interim material frequently used in prosthodontics-and of PEEK (polyether ether ketone)-a biomaterial which is placed on the border between interim and final prosthetic use-are highlighted in order to illustrate the complex way these materials interact with the oral environment. In regard to definitive prosthetic materials used for obtaining implant-supported prostheses, emphasis is placed on zirconia-based ceramics. Zirconia exhibits several distinctive advantages (excellent aesthetics, good mechanical behavior, biocompatibility), through which its clinical applicability has become increasingly wide. Zirconia's interaction with the oral environment (fibroblasts, osteoblasts, dental pulp cells, macrophages) is presented in a relevant synthesis, thus revealing its good biocompatibility.

Meta-analytical analysis on components released from resin-based dental materials

OBJECTIVES

Resin-based materials are applied in every branch of dentistry. Due to their tendency to release substances in the oral environment, doubts have been raised about their actual safety. This review aims to provide a comprehensive analysis of the last decade literature regarding the concentrations of elutable substances released from dental resin-based materials in different type of solvents.

MATERIALS AND METHODS

All the literature published on dental journals between January 2010 and April 2022 was searched using international databases (PubMed, Scopus, Web of Science). Due to strict inclusion criteria, only 23 papers out of 877 were considered eligible. The concentration of eluted substances related to surface and volume of the sample was analyzed, considering data at 24 h as a reference. The total cumulative release was examined as well.

RESULTS

The most eluted substances were HEMA, TEGDMA, and BPA, while the less eluted were Bis-GMA and UDMA. Organic solvents caused significantly higher release of substances than water-based ones. A statistically significant inverse correlation between the release of molecules and their molecular mass was observed. A statistically significant positive correlation between the amount of released molecule and the specimen surface area was detected, as well as a weak positive correlation between the release and the specimen volume.

CONCLUSIONS

Type of solvent, molecular mass of eluates, and specimen surface and volume affect substances release from materials.

CLINICAL RELEVANCE

It could be advisable to rely on materials based on monomers with a reduced elution tendency for clinical procedures.

Effects of Monomer Composition of Urethane Methacrylate Based Resins on the C=C Degree of Conversion, Residual Monomer Content and Mechanical Properties

(1) Background: This study investigated the influence of Bis-GMA, TEGDMA, UDMA, and two different polyethylene glycol (PEG)-containing, UDMO-based co-monomers on the Young’s modulus and flexural strength, degree of methacrylate C=C double bond conversion and residual monomer elution of experimental dental resins. (2) Methods: Urethane methacrylate-based monomer was synthesised via a radical chain growth polymerization mechanism using PEG in order to improve the mechanical properties. Dental resins were formulated using Bis-GMA, UDMA, or UDMO as base monomers combined with TEGDMA as a dilution monomer and DMAEM + CQ as the photo-initiator system. Degree of conversion (DC), mechanical properties, and residual monomer content of light-activated methacrylate resin formulations were evaluated and statistically analysed by ANOVA and a Tukey’s test. (3) Results: PEG-containing UDMO resins had lower Young’s modulus and elastic strength than UDMA-derived resin for all irradiation times. The highest DC (67,418%) was observed for the PEG-containing UDMO-based resin formulation when light cured for 40 s. For all samples, DC increased with the photo-polymerization time. The amount of residual monomer decreased after increasing the light-curing period from 20 to 40 s, resin with UDMO content 0.01 mol of PEG having the smallest amount of free eluted monomer. (4) Conclusions: A strong structure–property relationship exists in photo-cured dimethacrylate-based dental resins. The time and quantity of the photochemical initiation system can influence the physical–mechanical properties of the resins but also the monomers in their composition.

Monomer Elution from Three Resin Composites at Two Different Time Interval Using High Performance Liquid Chromatography-An In-Vitro Study

Esthetics, improved colour stability and ease of contour have made photo-activated resin based restorative materials being widely used in routine dental clinical practice. Perhaps improper and inadequate polymerization of resin based composite material might lead to elution of monomer. Thus, the aim of the current study was to quantify the monomer elution from three resin composites. The intended analysis was made using high performance liquid chromatography (HPLC) at two different time periods. Three different materials that were investigated in the current study included Swiss Tech resin composite (Group A), Ceram X (Group B) and Beautifil Injectable composite (Group C). Ten cylindrical samples were fabricated in each study group. In 75% wt of ethanol, the samples were ingressed immediately and stored at room temperature. A 0.5 mL of the samples was assessed at pre-defined time intervals at 24 h and 7th day. Later, assessment of the samples was performed with HPLC and the data was analyzed using statistical test. Bisphenol A-glycidyl methacrylate (Bis-GMA), Triethylene glycol dimethacrylate (TEGDMA), 2-hydroxyethyl methacrylate (HEMA) and Urethane dimethacrylate (UDMA) were quantified in the samples. When analyzing the release monomer, it was found that at the end of 24 h Bis-GMA was eluted more in the injectable resin composite whereas, TEGDMA was eluted from Swiss Tech and Ceram X resin composites. At the end of the 7th day it was evident that Bis-GMA was eluted maximum in all the three resin composites. Thus, monomer release was found to be evident among all three resin composites and it is of utmost important to be assessed in routine clinical practice.

Identification of chemicals leaching from dental resin-based materials after in vitro chemical and salivary degradation

OBJECTIVES

Only little is known about degradation of methacrylate monomers. Therefore, using in vitro chemical and saliva degradation this study aimed to identify the degradation products of organic compounds present in resin-based dental materials.

METHODS

Ten dental monomers and nine polymerized dental resin-based materials were immersed for 24 h in chemical media (0.1 M HCl, 0.1 M NaOH) and human pooled saliva in order to identify leached monomers and degradation products from chemical and saliva degradation. Samples were analyzed using liquid chromatography coupled to high-resolution mass spectrometry to identify previously unknown degradation products.

RESULTS

During in vitro chemical degradation, uncured monomers were rapidly hydrolyzed into mono- and demethacrylated degradation products. During chemical degradation in alkaline conditions of polymerized materials, considered the worst-case scenario, only degradation products could be detected. In acidic conditions, monomers and their degradation products were detected. In addition, different additives such as EDMAB, DMPA and HMBP were present in acidic degradation samples. Degradation in human pooled saliva for 24 h to mimic the in vivo situation, resulted in the identification of both monomers and their degradation products.

CLINICAL SIGNIFICANCE

Using state-of-the-art high-resolution mass spectrometry previously unknown degradation products of commonly used monomers were identified for the first time. Results show that patients may be exposed to monomers and their degradation products in the first 24 h after restorative procedures. The results provide a base for further research on the degradation of resin-based dental composites in order to assess their safety using elution and toxicity studies.

Pre-Heating Effect on Monomer Elution and Degree of Conversion of Contemporary and Thermoviscous Bulk-Fill Resin-Based Dental Composites

Detection of unreacted monomers from pre-heated resin-based dental composites (RBC) is not a well-investigated topic so far. The objectives were to determine the temperature changes during the application and polymerization, the degree of conversion (DC) and unreacted monomer elution of room temperature (RT), and pre-heated thermoviscous [VisCalor Bulk(VCB)] and high-viscosity full-body contemporary [Filtek One Bulk(FOB)] bulk-fill RBCs. The RBCs' temperatures during the sample preparation were recorded with a K-type thermocouple. The DC at the top and bottom was measured with micro-Raman spectroscopy and the amounts of eluted BisGMA, UDMA, DDMA, and TEGDMA were assessed with High-Performance Liquid Chromatography. The temperatures of the pre-heated RBCs decreased rapidly during the manipulation phase. The temperature rise during photopolymerization reflects the bottom DCs. The differences in DC% between the top and the bottom were significant. RT VCB had a lower DC% compared to FOB. Pre-heating did not influence the DC, except on the bottom surface of FOB where a significant decrease was measured. Pre-heating significantly decreased the elution of BisGMA, UDMA, DDMA in the case of FOB, meanwhile, it had no effect on monomer release from VCB, except TEGDMA, which elution was decreased. In comparison, RBC composition had a stronger influence on DC and monomer elution, than pre-cure temperature.

Effect of Polymerization Time on Residual Monomer Release in Dental Composite: In Vitro Study

Light activated resin-based composites are the most accepted and used materials among clinicians. The aim of this study is to determine the amount of residual monomer released from nanofiller composite resins for different polymerization times and storage periods in vitro. To this purpose, Tetric Ceram (Ivoclar, Liechtenstein), Clearfil Majesty Posterior (Kuraray, Japan), Grandio (VOCO, Germany), and Filtek Ultimate Universal (3M, USA) were used as nanofiller resin composites samples. Four groups ( $n=40$ , diameter: 5 mm, thickness: 2 mm) of each material were fabricated, and each group was exposed to three different polymerization time (10, 20 and 40 sec). High-performance liquid chromatography (HPLC) was used to measure the amount of monomers released over 1, 15, and 30 days. The highest amount of monomer release was seen in Tetric EvoCream composite, while the least monomer release was seen in Clearfil Majesty composite. Regardless of the polymerization time, material, or storage period, the highest amount of eluted monomer was Bis-GMA. It is observed that there is no statistically significant difference between various polymerization times. Monomer release reached its highest level on the 15th day and decreased on the 30th day for all composites. Polymerization time did not affect the monomer release from the composites, but the type of the monomers and concentration of the filler used in the composites affected the amount of released monomers. The use of TEGDMA (co)monomer reduced the monomer release.

A Review on Current Trends of Polymers in Orthodontics: BPA-Free and Smart Materials

Polymeric materials have always established an edge over other classes of materials due to their potential applications in various fields of biomedical engineering. Orthodontics is an emerging field in which polymers have attracted the enormous attention of researchers. In particular, thermoplastic materials have a great future utility in orthodontics, both as aligners and as retainer appliances. In recent years, the use of polycarbonate brackets and base monomers bisphenol A glycerolate dimethacrylate (bis-GMA) has been associated with the potential release of bisphenol A (BPA) in the oral environment. BPA is a toxic compound that acts as an endocrine disruptor that can affect human health. Therefore, there is a continuous search for non-BPA materials with satisfactory mechanical properties and an esthetic appearance as an alternative to polycarbonate brackets and conventional bis-GMA compounds. This study aims to review the recent developments of BPA-free monomers in the application of resin dental composites and adhesives. The most promising polymeric smart materials are also discussed for their relevance to future orthodontic applications.

Effects of Bisphenol A Released From Composite Fillings on Reproductive Hormone Levels in Men

Objectives

Composite resins are the most preferred filling material because of their excellent aesthetic qualities. However, a filling material should also be biocompatible as well as aesthetic. The aim of this study was to determine the serum and saliva bisphenol-A (BPA) levels and to examine the effects of serum BPA on reproductive hormone levels after healthy men were treated with composite fillings.

Methods

Eighteen healthy males each received 2 composite restorations. Saliva and blood samples of subjects were collected before resin application and 1 day and 1, 3, and 5 weeks after the resin was applied. BPA amounts in samples were detected using high-performance liquid chromatography (HPLC). Serum gonadotropins, testosterone, sex hormone binding globulin, free androgen index, and oestrogen levels were measured with radioimmunological assay kits. Statistical analysis of data was made using Friedman, Wilcoxon signed ranks and Mann-Whitney U tests (α = 0.05).

Results

The amount of BPA released from composite resins over time was not significantly elevated in either saliva or serum (P > 0.5). In addition, serum BPA levels were significantly higher than saliva BPA levels for both composites (P < .05), but saliva and serum BPA levels were not statistically different when comparing the 2 composites (P > .05).

Conclusions

BPA from composite resins used in this study did not significantly alter serum hormone levels.

Effect of layer thickness on the elution of monomers from two high viscosity bulk-fill composites: A high-performance liquid chromatography analysis

Aim:

The aim is to evaluate the effect of different layer thickness on the amount of elution of monomers from two high viscosity bulk-fill composites after 24 h and 1 month storage in ethanol using high-performance liquid chromatography (HPLC) analysis.

Materials and Methods:

Forty-eight samples prepared from two high viscosity bulk-fill composite resins; Tetric EvoCeram Bulk Fill and x-tra fil were divided into three groups (n = 8) based on their layer thickness, i.e., Group 1 (2 mm), Group 2 (4 mm), and Group 3 (6 mm) and were then subdivided based on their storage period. The analysis of the eluates was performed using HPLC unit. Statistical analysis was performed using One-way ANOVA, independent sample t-test, and paired “t” test at a significance level of 0.05 (P < 0.05).

Results:

Increase in layer thickness resulted in increased amount of bisphenol A-glycidyl methacrylate (Bis-GMA) and urethane dimethacrylate (UDMA) elution for both composites, i.e., Group 3 > Group 2 > Group 1 and there was statistically significant difference among all the groups. Tetric EvoCeram Bulk Fill showed a statistically significant increase in amount of Bis-GMA and UDMA elution for all groups compared to x-tra fil. Furthermore, increase in storage period resulted in statistically significant increase in amount of Bis-GMA and UDMA elution for both composites, i.e., Group 1B > Group 1A, Group 2B > Group 2A, and Group 3B > Group 3A. The mean value of UDMA elution was higher when compared to that of Bis-GMA elution for both composites and there was statistically significant difference for all groups.

Conclusion:

Within the limitations of this in vitro study, it was concluded that increase in layer thickness resulted in increased amount of Bis-GMA and UDMA elution for both Tetric EvoCeram Bulk Fill and x-tra fil.

Color stability of a bulk-fill composite resin light-cured at different distances

The aim of this in vitro study was to evaluate the color stability of a bulk-fill (Filtek One Bulk Fill, 3M ESPE) and a conventional (Filtek Z350 XT, 3M ESPE) composite resin light-cured at different distances, before and after being submitted to staining with a coffee solution. Sixty specimens of each composite resin were prepared and light-cured at distances of 0, 2 and 4 mm, using a LED light-curing unit (Valo, Ultradent). The specimens were separated (n = 10) for immersion in either distilled water or coffee solution (10 minutes a day for 8 days) to stimulate staining. Color evaluations were performed before and after immersion in the solutions, according to CIELab (△Eab), CIEDE2000 (△E00) and the Whiteness Index for Dentistry (△WID). Kruskal Wallis and Dunn tests, Mann-Whitney tests and Wilcoxon test were applied (α = 5 %). The a* value for conventional composite resin showed a significant increase after immersion in coffee and distilled water (p < 0.05). Both composite resins showed greater b* values when immersed in coffee than in distilled water, with no significant difference among the light-activation distances (p > 0.05). There was no significant difference for L* among the light-activation distances; both resins showed significant decrease in L* after immersion in coffee (p < 0.05). Color change (△Eab, △E00) and difference in whiteness (△WID) were higher for conventional resin when immersed in the coffee solution at all the light-activation distances. Conventional composite resin presented a higher staining value than bulk-fill composite resin, regardless of the light-activation distance.

The effect of pre-heating on monomer elution from bulk-fill resin composites

Background

The present study was aimed to evaluate the effect of pre-heating of bulk -fill resin composites on monomer elution from them.

Material and Methods

Three different types of resin composites were used including Tetric N-Ceram Bulk Fill, X-tra Fill and X-tra Base. 10 cylindrical samples were prepared from each resin composites. Before light curing, 5 samples were pre-heated until reaching 68˚C, then 5 other samples were polymerized at room temperature. After 24 hours, release of UDMA, TEGDMA and BIS-GMA monomers were measured by High-Performance Liquid Chromatography analysis. Data analysis was performed by two-way ANOVA test, Games-Howell and Sidak post hoc tests.

Results

Pre-heating did not have any statistically significant effect on the mean values of UDMA, TEGDMA and Bis-GMA elution (p>0.05). The greatest amount of released Bis-GMA and UDMA was obtained from Tetric N-Ceram Bulk-fill composite. The greatest amount of released TEGDMA was obtained from X-tra Fill composite. X-tra Base composite showed the lowest amount of monomer release (P<0.001).

Conclusions

Pre-heating did not have any effect on monomer release from bulk-fill resin composites. Moreover, the amount and the type of monomers released from various bulk-fill resin composites were not similar.

Key words:Bulk fill composite resin, elution, HPLC, residual monomer, temperature.

Comparative analysis of the surface roughness of conventional resins and filling after immersion in mouthwashes

Aim: Bulk Fill composite resins were released on the market in order to reduce the time in clinical sessions by using increments of up to 5.0 mm thickness. The aim of this study was to evaluate the effect of the rinsing solutions on the surface roughness of the conventional composite and Bulk fill composite resins. Methods: 40 specimens were prepared from a 4.0mm x 10.0mm teflon matrix and photoactivated for 20 seconds, with 20 specimens made of Filtek Bulk-Fill composite resin (3M ESPE) and 20 specimens made with Filtek™ Z350 XT composite resin (3M ESPE). Each group was subdivided into 2 subgroups: G1 (Filtek™ Z350 XT-3M ESPE-immersed in Colgate PlaxWhitening®); G2 (Filtek™ Z350 XT-3M ESPE-immersed in PlaxFreshMint®); G3 (Filtek™ Bulk-Fill-3M ESPE-immersed in Colgate PlaxWhitening®) and G4 (Filtek™ Bulk-Fill-3M ESPE-immersed in Colgate PlaxFreshMint®). The surface roughness test was performed initially and after immersion in rinses by the Time Group Inc.-TR200® rugosimeter apparatus and the data were submitted to statistical analysis (two-way repeated measures ANOVA). Results: Surface roughness values of the Filtek™ Bulk-Fill composite resin (3M ESPE) were significantly higher than the Filtek™ Z350 XT composite resin (3M ESPE) (P <0.0001). However, no differences were identified before and after immersion in rinses with or without alcohol. Conclusion: The use of mouthwashes does not interfere with the surface roughness of the tested resins, but the composite resin Filtek Z350 XT (3M ESPE) presents a surface with less roughness.

A Review on the Biocompatibility of PMMA-Based Dental Materials for Interim Prosthetic Restorations with a Glimpse into their Modern Manufacturing Techniques

This paper's primary aim is to outline relevant aspects regarding the biocompatibility of PMMA (poly(methyl methacrylate))-based materials used for obtaining interim prosthetic restorations, such as the interaction with oral epithelial cells, fibroblasts or dental pulp cells, the salivary oxidative stress response, and monomer release. Additionally, the oral environment's biochemical response to modern interim dental materials containing PMMA (obtained via subtractive or additive methods) is highlighted in this review. The studies included in this paper confirmed that PMMA-based materials interact in a complex way with the oral environment, and therefore, different concerns about the possible adverse oral effects caused by these materials were analyzed. Adjacent to these aspects, the present work describes several advantages of PMMA-based dental materials. Moreover, the paper underlines that recent scientific studies ascertain that the modern techniques used for obtaining interim prosthetic materials, milled PMMA, and 3D (three-dimensional) printed resins, have distinctive advantages compared to the conventional ones. However, considering the limited number of studies focusing on the chemical composition and biocompatibility of these modern interim prosthetic materials, especially for the 3D printed ones, more aspects regarding their interaction with the oral environment need to be further investigated.

Monomer release from bulk-fill composite resins in different curing protocols

The purpose of this study was to determine the depth of cure and the type and amount of monomers released from bulk-fill composites in different curing protocols. Five different composite resins Filtek Bulk-Fill Posterior, Filtek Bulk-Fill Flowable, SureFil SDR, X-tra Fil, and X-tra base, were used. A light-emitting diode (LED) device was used in 3 different modes (standard, high power, and extra power mode), and a halogen light device was also used as a control. Surface hardness was measured and the depth of cure was calculated. Monomer analysis was performed using high performance liquid chromatography (HPLC). The data were analyzed using Tamhane's T2 post-hoc test (α = 0.05). The cure depth for all materials except for Filtek Bulk-Fill Posterior (extra power mode) and Filtek Bulk-Fill Flowable (high power and extra power modes) was over 80%. Under the conditions of this study, the amount of monomer released from composite resins changed according to the type of composite resin and the light mode used.

[Factors influencing clinical application of bulk-fill composite resin]

Bulk-fill composite resin are simple to operate, and they reduce polymerization shrinkage and microleakage compare to traditional resin-based composites. However, their clinical application could be affected by numerous factors, such as the material itself, light curing, placement techniques, storage condition, and preheating. This review aimed to summarize the definitions, classifications, indications, clinical properties, and influencing factors of the clinical application of bulk-fill resin-based composites and discuss the ways to improve their clinical effectiveness.

New Resin-Based Bulk-Fill Composites: in vitro Evaluation of Micro-Hardness and Depth of Cure as Infection Risk Indexes

The current in vitro study evaluated the Vickers hardness number (VHN) and hardness ratio of four bulk-fill composites (VisCalor bulk; Admira Fusion x-tra; x-tra fil; and GrandioSO x-tra-Voco, Cuxhaven, Germany) to assess the risk of bacterial colonization in comparison with standard composite materials. Thirty samples were prepared for each group. The VHN of both the external (top) and internal surface (bottom) was determined with a micro-hardness tester (200 g load for 15 s), and the hardness ratio was also calculated for each sample. Subsequently, storage in an acidic soft drink (Coca-Cola, Coca-Cola Company, Milano, Italy) was performed; for each group, 10 samples were stored for 1 day, while another 10 were stored for 7 days and the remaining 10 were kept in water as controls. A significant reduction in VHN was shown for all the groups when comparing the external versus internal side (P < 0.05), although the hardness ratio was greater than 0.80, resulting in an adequate polymerization. Regarding the acid storage, all the groups showed a significant decrease of VHN when compared with the controls, both after 1 day (P < 0.05) and after 7 days (P < 0.001). All the products showed adequate depth of cure without further risk of bacterial colonization. However, acid exposure negatively affected micro-hardness values, which might promote subsequent colonization.

Cytotoxic effects of contemporary bulk-fill dental composites: A real-time cell analysis

The aim of this study was to evaluate the cytotoxicity of contemporary flowable and paste-like bulk-fill dental composites by using a real-time cell analysis. In the present paper, cytotoxicity levels of five flowable, five paste-like bulk-fill composite materials and one conventional flowable, one conventional paste-like resin composite were examined on L929 mouse fibroblast cell line. After seeding 25,000 cells/300 μL/well cell suspensions into the wells of an E-plate, test materials were added and observed at every 30 min intervals for 72 h. Kruskal Wallis H and Mann Whitney U multiple comparison tests were used to analyze the results. Pre-reacted glass-ionomer (PRG) containing bulk-fill composites were severely toxic at all time points (24, 48 and 72 h, p<0.05). None of the tested composites demonstrated high cell viability (>70%) at 48 and 72 h. Flowable and paste-like composites of the same brand exhibited similar cytotoxic properties (p>0.05).

Influence of the degree of conversion and Bis-GMA residues of bulk fill resins on tissue toxicity in an subcutaneous model in rats

AIM

To analyse the influence of the degree of conversion (DC) and light curing residues of different bulk fills (BFs) composites on the inflammatory profile in the subcutaneous tissue of rats.

MATERIALS AND METHODS

Resin disks of BF-resins and their active conventional resins (CR; 3M®, Ivoclar®, and Kerr®) were light-cured at 2 mm (BF-superficial) and 4 mm (BF-deep) thicknesses and analyzed by infrared spectroscopy (FTIR; n = 3/group; DC and light curing residues). Then, the disks were implanted in four quadrants in the subcutaneous tissue of Wistar rats (sham, CR, BF-superficial and RF-deep), and after 7, 14, and 28 days, the animals (n = 6/day) were euthanized for histological analysis of the intensity of the inflammatory process (scores 0-3). Kruskal-Wallis/Dunn and ANOVA/Bonferroni tests were used (p < 0.05, Graph Pad Prism 5.0).

RESULTS

The DC of CR 3M® did not differ significantly compared to BF-superficial and BF-deep resins (p = 0.235). The Ivoclar® and Kerr® resins showed a higher DC with CR and BF-superficial compared to the BF-deep (p = 0.005 and p = 0.011, rctively). Kerr® resins showed a higher Bis-GMA/UDMA ratio, especially in BF-deep resin (p < 0.05). 3M® and Ivoclar resins did not show high inflammation scores, but for Kerr® BF resins (superficial and deep), the inflammatory process was significantly higher than that in the CR and sham quadrants (p = 0.031).

CONCLUSION

The tissue inflammatory response after resin inoculation depends on the DC and light curing residues of Bis-GMA.

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

Objective:

The aim of this study was to evaluate the degree of conversion (DC) through micro-Raman spectroscopy and surface microhardness in Vickers hardness (VHN) of three new dual-cure bulk-fill resin-based composites (RBCs) compared with light-cure bulk-fill and incremental RBCs at two clinically relevant depths and for two light irradiation times.

Methods:

Three commercially available restorative dual-cure bulk-fill RBCs (BulkEZ, HyperFIL, and Injectafil) were evaluated and compared with three light-cure RBCs (Filtek Bulk Fill Flowable, Filtek One Bulk Fill, and incremental Filtek Z250) as controls. Specimens were prepared in two different depths (0.5 mm and 5 mm) and were light irradiated for 20 seconds or 40 seconds. Self-cure was also evaluated for the three dual-cure bulk-fill RBCs. Micro-Raman spectroscopic measurements and VHN tests (n=5) were made after 24 hours of dry storage in the dark at room temperature for all test conditions. Data were analyzed using one-way and two-way analyses of variance (α=0.05).

Results:

All tested RBCs showed significantly higher DC and VHN values at 0.5-mm depth than at 5-mm depth, with the exception of BulkEZ, which showed similar DC and VHN values at two depths. The three dual-cure bulk-fill RBCs showed significantly higher DC than the three light-cure RBCs under the same curing condition. The three dual-cure RBCs showed much smaller differences in VHN values between the two depths than the three light-cure RBCs. Twenty seconds and 40 seconds of light irradiation did not generate significant difference in DC and VHN values for the three dual-cure bulk-fill RBCs at either depth or for the three light-cure RBCs at the 0.5-mm depth; however, 40 seconds of light irradiation generated significantly higher DC and VHN values for One Bulk Fill and Z250 at the 5-mm depth compared with 20 seconds of light irradiation.

Effect of thermocycling on the amount of monomer released from bulk fill composite resins

The goal of this study was to examine the effect of thermal cycling on the amount of monomer released from bulk fill composites. Five bulk fill composite resins were used in the study. Extraction solutions were obtained at the end of the time/thermal cycle periods: 0-1 day/0-1,500, 1-3 days/1,500-4,500 and 3-7 days/4,500-10,000. The monomers in the extractions samples taken at each time point were measured on an HPLC instrument. The obtained data were analyzed by repeated measures of variance analysis and tukey multiple comparison tests (p<0.05). The thermocycling increased the amount of monomer released from all composites at 0-1 day (p<0.05). At 0-1 and 1-3 days, Venus Bulk Fill and Filtek Bulk Fill composite resins were more affected. Polymer networks with high molecular weight monomers such as Bis-GMA and UDMA can be less affected by thermal changes compared to polymers with low molecular weight monomers.

Depth-Dependent Cellular Response from Dental Bulk-Fill Resins in Human Dental Pulp Stem Cells

The proper choice of dental composite resins is necessary based on the minimal cytotoxicity and antiodontogenesis on human dental pulp stem cells for dental pulp-dentin tissue repair and regeneration. The aim of this study was to evaluate the cytotoxicity and antidifferentiation effects of dental bulk-fill resins, able to be polymerized as a bulk status for filling deep cavity of a tooth by single light curing, against human dental pulp stem cells (hDPSCs) from three compartments corresponding to depth (0-2, 2-4, and 4-6 mm) from the light-curing site. Three bulk-fill composite resins (SDR, Venus bulk-fill (VBF), and Beautifil Bulk Flowable (BBF)) and a conventional flowable composite resin (Filtek Z350 XT flowable restorative (ZFF)) were individually filled into a cylindrical hole (h = 2 mm, Ф = 10 mm), and three compartments (total ~6 mm of height) were combined as a single assembly for light curing. The resin samples from the three layers were separated and eluted in the culture medium. The extracts were exposed to hDPSCs, and cytotoxicity and differentiation capability were evaluated. Depth of cure and surface hardness according to depth were determined. All bulk-fill resins except BBF revealed cytotoxicity from 4 to 6 or 2 to 4 mm, while ZFF was cytotoxic at over 2 mm. Depth of cure was detected from 3.55 to 4.02 mm in the bulk-fill resins (vs. ~2.25 mm in conventional resin), and 80% hardness compared with that of a fully polymerized top surface was determined from 4.2 to 6 mm in the bulk-fill resin (vs. 2.4 mm in conventional resin). Antidifferentiation was revealed at a depth of 4-6 mm in the bulk-fill resin. There was a difference in depth of cytotoxicity and antidifferentiation between the bulk-fill composite resins, which was mainly due to different cure depths and ingredients. Therefore, careful consideration of choice of bulk-fill resins is necessary especially for restoration of deep cavities for maintaining the viability and differentiation ability of dental pulp stem cells.

Interfacial Properties and Bottom/Top Hardness Ratio Produced by Bulk Fill Composites in Dentin Cavities

The aim of this study was to evaluate the bond strength, bottom/top hardness ratio, marginal adaptation, and interfacial nanoleakage of regular viscosity bulk fill composites (RVBFC) and regular viscosity traditional composites (RVTC). Two RVBFC (Filtek Bulk Fill and Aura Bulk Fill) and two RVTC (Filtek Z250XT and Aura) were assessed. Forty conical cavities (4.8×2.8×4.0) were prepared in bovine dentin and restored with composites (n=10). After 24h in water, marginal adaptation was evaluated by staining with a caries detector. The top and bottom surfaces of the conical restorations were stained for five seconds and the gap percentage in the composite/dentin interface was determined using digital images on a measurement program (ImageTool). The Vickers microhardness was measured and the bottom/top microhardness ratio (B/T) was determined. Push-out bond strength test was performed in a universal testing machine (0.5mm/min) and failure modes were evaluated in a stereomicroscope (20×). Other specimens (n=3) were produced for interfacial nanoleakage evaluation. Data were analyzed using one and two-way ANOVA and Tukey's test (α=0.05). The gap percentage was higher in the bottom compared to the top. The B/T ratio of the Aura Bulk Fill was statistically lower than other composites. Push-out bond strength were similar among composites. The RVBFC presented lower nanoleakage than the RVTC in the bottom of the conical restoration and there was no difference among the materials in the top surfaces. In conclusion, Filtek Bulk Fill performed better than Aura Bulk Fill regarding the analyzed properties.

N-Acetyl Cysteine as a Novel Polymethyl Methacrylate Resin Component: Protection against Cell Apoptosis and Genotoxicity

The present study investigated the antiapoptotic and antigenotoxic capabilities of N-acetyl cysteine- (NAC-) containing polymethyl methacrylate (PMMA) resin. An in vitro Transwell insert model was used to mimic the clinical provisional restorations placed on vital teeth. Various parameters associated with cell apoptosis and genotoxicity were investigated to obtain a deeper insight into the underlying mechanisms. The exposure of human dental pulp cell (hDPC) cultures to the PMMA resin (Unifast Trad™) resulted in a rapid increase in reactive oxygen species (ROS) level beginning at 1 h, which was followed by time-dependent cell detachment and overt death. The formation of γ-H2AX and cell cycle G1 phase arrest indicated that oxidative DNA damage occurred as a result of the interactions between DNA bases and ROS, beyond the capacities of cellular redox regulation. Such oxidative DNA damage triggers the activation of p53 via the ataxia telangiectasia mutated (ATM) signaling pathway and the induction of intrinsic mitochondrial apoptosis. Oxidative stress, cell apoptosis, and DNA damage induced by the PMMA resin were recovered to almost the level of untreated controls by the incorporation of NAC. The results indicate that the PMMA resin induced the intrinsic mitochondrial apoptosis as a consequence of p53 activation via the ATM pathway in response to oxidative DNA damage. More importantly, the incorporation of NAC as a novel component into the Unifast Trad™ PMMA resin offers protective effects against cell apoptosis and genotoxicity. This procedure represents a beneficial strategy for developing more biocompatible PMMA-based resin materials.

In Vitro Cytotoxicity of Self-Adhesive Dual-Cured Resin Cement Polymerized Beneath Three Different Cusp Inclinations of Zirconia

The aim of the present study was to evaluate the in vitro cytotoxicity of self-adhesive dual-cured resin cement (SADRC) polymerized beneath three different cusp inclinations of zirconia with different light curing time. A commercial SADRC (Multilink Speed) was polymerized beneath zirconia (ZrO₂) with three different cusp inclinations (0°, 20°, and 30°) for 20 s or 40 s. After being stored in light-proof box for 24 h, the ZrO₂-SADRC specimens were immersed in DMEM for 72 h and then we got the extract solution, cultured the human gingival fibroblasts (HGF, 8 × 10³ per well) with 100% or 50% concentrations of the extract solution for 24 h, 72 h, and 120 h, respectively, and evaluated cytotoxicity of the polymerized SADRC with CCK-8 assay in optical density (OD) values, relative growth rates (RGR), and cytotoxicity grades. Statistical analysis was conducted using a two-way ANOVA followed by post hoc Student–Newman–Keuls test. The OD values varied from 0.8930 to 3.2920, the RGR varied from 33.93% to 98.68%, and the cytotoxicity grades varied from 0 to 2. There was significant difference in the OD values among the different cusp inclinations of zirconia (P < 0.001), and there was significant difference in the OD values between the different light curing times in some situations (P < 0.05). The cusp inclination of zirconia affects the in vitro cytotoxicity of SADRC. Prolonging the light curing time from 20 s to 40 s can reduce the in vitro cytotoxicity of SADRC when the cusp inclination of zirconia is smaller than 20°.

Monomer release from nanohybrid composites after bleaching

The evaluation of the effect of bleaching on monomer release from two composite resins was performed by bleaching two nanohybrid composite resins Filtek Z550 and Tetric N-Ceram using two bleaching products Whiteness HP Maxx and Vivastyle. In total, 20 samples were made from each composite resin from which four groups were fabricated (two for each bleaching product). The samples were stored in a 75% ethanol solution, and the solutions were renewed after 1, 7, and 28 days. The monomer release was analyzed using high performance liquid chromatography. The data were analyzed using repeated measures analysis of variance and least significant difference multiple comparison test (α = 0.05). Monomers were found to be released from both composite resins. The amounts of monomer released were found to decrease over time (P < 0.05); however, the resins were not affected by bleaching, and the released monomers were well below toxic doses.

Shear bond strength and interface analysis between a resin composite and a recent high-viscous glass ionomer cement bonded with various adhesive systems

OBJECTIVE

This study investigated the shear bond strength (SBS) and interface between a resin composite and a new high-viscous glass ionomer cement (HV-GIC), a HV-GIC, a resin-modified glass ionomer cement (RM-GIC), a bulk-fill flowable composite, and a regular flowable composite bonded with various adhesive systems.

METHODS AND MATERIALS

A resin composite (Filtek Z350) was bonded to a new HV-GIC (EQUIA Forte Fil) using various adhesive systems, including a universal adhesive in self-etch and etch-and-rinse mode (Scotchbond Universal), a two-step etch-and-rinse adhesive (Scotchbond 1-XT), a one-step self-etch adhesive (Optibond All-in-one) tested also after silane application (Monobond Plus), and a coating material (EQUIA Forte Coat). The resin composite was also bonded to a HV-GIC (Fuji IX GP), a RM-GIC (Fuji II LC), a bulk-fill flowable composite (SDR), and a regular flowable composite (Tetric Evo Flow) with the universal adhesive in self-etch mode (Scotchbond Universal). Two-way ANOVA followed by Dunnett's post hoc test was used to investigate the difference in SBS. Failures were analyzed by chi-square test. Bonding interfaces were examined by environmental scanning electron microscopy (E-SEM).

RESULTS

SBS to EQUIA Forte Fil was significantly lower with Scotchbond 1-XT than with all other adhesive systems. By using Scotchbond Universal with the self-etch technique, the SBS to EQUIA Forte Fil was significantly higher than the SBS to Fuji IX GP and significantly lower than the SBS to Fuji II LC, SDR, and Tetric Evo Flow. E-SEM images showed an intimate contact at all interfaces examined.

CONCLUSION

EQUIA Forte Fil showed satisfactory SBS and interfaces with all adhesives tested.

CLINICAL RELEVANCE

Bonding between the resin composite and HV-GIC can be achieved using a universal adhesive in self-etch mode, an easy-to-use adhesive system.

Investigation of the chemical profile and cytotoxicity evaluation of organic components eluted from pit and fissure sealants

The aim of this study was to identify organic components eluted from five resin dental sealants using gas chromatography and mass spectrometry (GC/MS) after 1-day and 40-days storage and the effect of sealants on cell survival of cultured fibroblasts. Five resin materials were studied: BeautiSealant (SHOFU), Clinpro (3M/ESPE), Conseal F (SDI), Grandio Seal (VOCO) and Helioseal Clear (Ivoclar/Vivadent). The organic monomers detected were butylated hydroxytoluene (BHT), bis-phenol-A (BPA), camphoroquinone (CQ), diethylenglycoldimethacrylate (DEGDMA), 4N, N-dimethylaminobenzoic acid butylethoxyester (DMABEE), hydroxyethylmethcrylate (HEMA), hydroquinone monomethylether (MEHQ), triethylene glycol dimethacrylate (TEGDMA), tetrabutylammonium tetrafluoroborate (TBATFB), triphenylstibane (TPSb). The main monomer detected was TEGDMA, whereas BHT and DEGDMA were detected at lower concentrations. Higher monomer concentrations were detected after 40 days storage. The eluting chemical profiles of the tested materials differ qualitative and quantitative. For cytotoxicity evaluation, NIH/3T3 cells were exposed to eluates of sealants and cell viability was assessed by a quantitative technique at two observation periods. Decreased cell viability was observed. The cytotoxicity and the release of monomers from dental materials examined depends on the type of material and the observation time point. Resin-based dental materials have raised public concerns regarding possible adverse biological effects, thus it is essential to evaluate possible side effects for human health.

Analysis of Base Monomer Elution from 3 Flowable Bulk-Fill Composite Resins Using High Performance Liquid Chromatography (HPLC)

Background

The aim of this study was to evaluate the elution of BisGMA, UDMA, TEGDMA, and HEMA monomers from flowable bulk fill composite resins with different resin matrix compositions, polymerized in 4-mm-thick layers, into 3 elution media.

Material/Methods

Three bulk-fill (SDR^® (SDR), X-tra base (XB) and BEAUTIFIL-Bulk Flowable (BF)) resin-composites were tested. Cylindrical samples were immersed in 100% ethanol, 75% ethanol, and distilled water. The concentrations of the monomers were measured using the HLPC method (Agilent Technologies 1200 Series) after 1 and 24 h, as well as after 3, 7, 14, and 21 days.

Results

After polymerization of the tested resins, there was elution of the BisGMA, UDMA, TEGDMA, and HEMA monomers from the SDR and BF composites, but none of the tested monomers could be detected eluting from XB. The highest penetrations of the polymerized SDR and BF composites were observed in the 100% ethanol solution. This extraction medium eluted the highest amounts of free monomers. Some eluted monomers were not described in the composites Material Safety Data Sheets.

Conclusions

The elution of the residual monomers depended on the resin composition and the materials filler/resin matrix ratio. In composite materials, toxicity assessment should be carried out, and should consider both the material composition as given by the manufacturer, and also the residual monomers that elute from the polymerized material. The elution concentration and time of monomers from composites depended on the solvent used. The highest penetrations of the polymerized SDR and BF composites were observed in the 100% ethanol solution, and this extraction medium eluted the highest amounts of free monomers. The 75% ethanol was a more aggressive medium than water in terms of monomer elution from bulk fill composites.