Strain development in bulk-filled cavities of different depths characterized using a non-destructive acoustic emission approach

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

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

Simulating the shrinkage-induced interfacial damage around Class I composite resin restorations with damage mechanics

OBJECTIVES

To investigate the shrinkage-induced damage at the composite-tooth interface by finite element analysis (FEA) using the cohesive zone model (CZM).

METHODS

Axisymmetric models of Class I restorations were created to illustrate the interfacial damage around composite resin restorations of different dimensions, with polymerization shrinkage modeled analogously to thermal shrinkage. The damage to the adhesive interface was determined using a CZM based on the fracture strength and fracture energy. To show the effects of damage, conventional models with perfectly bonded composite resin restorations were created as controls.

RESULTS

The results indicated interfacial damage at the butt-joint cavosurface margin, dentinoenamel junction, and internal line angle. The percentage of damaged interfacial area was found to increase with decreasing diameter for restorations of the same height. For a given diameter, the damage was more severe for restorations of greater depth. The effects of the damage were further illustrated in the model with a restoration of 2-mm diameter and height. The interfacial damage occurred primarily at the internal line angle (83.3 % of all the damaged interfacial area), leading to local stress relief (from 18.3 MPa to 12.8 MPa), but also higher stress at the damage fronts. Greater local shrinkage was found in composites adjacent to the damage.

SIGNIFICANCE

The damage mechanics-based CZM is an essential refinement of the FEA to predict interfacial damage and its implications. The extent of damage was found to be greater around restorations with smaller diameters and greater depths. The entire simulation is available via an open-source platform to facilitate further applications in adhesive dentistry.

Experimental two-step universal adhesives bond durably in a challenging high C-factor cavity model

OBJECTIVES

To determine the bonding effectiveness of experimental 2-step universal adhesives (UAs) to high C-factor class-I cavity-bottom dentin and to assess the potential bond-strength contribution of an additional flowable composite layer.

METHODS

Three experimental 2-step UA formulations, involving the application of a 10-MDP-based primer followed by a hydrophobic adhesive resin with a 15-to-20-µm film thickness and differing only for filler, referred to as BZF-21 (silica and bioglass filler), BZF-29 (silica filler) and BZF-29_hv (higher silica-filler loading resulting in a higher viscosity), all prepared by GC, along with three representative commercial adhesives, Clearfil SE Bond 2 (C-SE2, Kuraray Noritake), G-Premio Bond (G-PrB, GC) and OptiBond FL (Opti-FL, Kerr), were comparatively investigated for their 'immediate' and 'aged' (50,000 thermocycles) micro-tensile bond strength (μTBS), when applied either in etch-and-rinse (E&R) or self-etch (SE) mode, to high C-factor class-I cavity-bottom dentin (n = 10; 10 experimental groups). Four additional experimental groups involved the extra application of the flowable composite G-ænial Universal Flo (GC), employed as an intermediate liner in combination with the adhesives BZF-29 and G-PrB and again applied both in E&R or SE mode. Statistical analysis was performed using linear mixed-effects (LME) modelling and linear regression analysis (p < 0.05).

RESULTS

All 2-step UAs performed similarly when compared to the gold-standard E&R Opti-FL and SE C-SE2 adhesives, except for the aged μTBS of BZF-29_hv applied in E&R mode, and significantly outperformed the 1-step UA G-PrB. Significant reduction in μTBS upon aging was only recorded for 2-step UAs applied in E&R mode. The extra flowable composite layer significantly improved G-PrB's μTBS.

SIGNIFICANCE

The experimental 2-step UAs revealed favorable bonding performance in the challenging high C-factor class-I cavity model, comparable to that of the multi-step gold-standard E&R and SE adhesives and superior to that of the 1-step UA investigated. An additionally applied flowable composite layer compensated for the lower bonding effectiveness of the 1-step UA in the high C-factor cavity model.

Influence of Factors in the Photopolymerization Process on Dental Composites Microhardness

The aim of the present paper is to investigate the influence of factors in photopolymerization process that govern microhardness of three types of dental composites-universal (UC), bulk-fill (BC), and flowable (FC). Cylindrical specimens with different thicknesses are made and light cured. The significance of light intensity, irradiation time, and layer thickness on Vickers microhardness is evaluated by experimental design, analysis of variance, and regression analysis. It is found that the main factor influencing the microhardness on the top surface of the three composites is light intensity. The second factor is layer thickness for the UC and FC, while for BC, it is curing time. The third factor is curing time for the first two composites and layer thickness for bulk-fill. The significance of factors' influence on the microhardness of the bottom surface is the same for the UC and FC, but different for BC. The main factor for the first two composites is layer thickness, followed by curing time and light intensity. For bulk-fill, curing time is main factor, light intensity is second, and layer thickness is last. Different significance of factors influencing the microhardness on top and bottom surfaces of investigated composites is revealed for the first time in the present study.

Time-lapse submicrometer particle motion reveals residual strain evolution and damaging stress relaxation in clinical resin composites sealing human root canals

Polymer based composites are widely used for treatment, for example as biofilm resistant seals of root canal fillings. Such clinical use, however, fails more frequently than other dental composite restorations, due to stress-related misfits. The reason for this is that the biomaterials used are inserted as viscous masses that may bond to the substrate, yet shrinkage stresses arising during setting of the cross-linking polymer, work against durable adhesion. Here we combine phase contrast enhanced time-lapse radiography (radioscopy), digital image correlation (DIC) and submicrometer resolution phase-contrast enhanced microtomography (PCE-CT), to reveal the spatial and temporal dynamics of composite polymerization and strain evolution. Radioscopy of cavities located in the upper part of human root canals demonstrates how the composite post-gelation "densification" is dominated by viscous flow with quantifiable motion of both particles and entrapped voids. Thereafter, these composites enter a "stress-relaxation" stage and exhibit several structural adaptations, induced by residual shrinkage stresses. Consequently critical alterations to the final biomaterial geometry emerge: (i) entrapped bubbles expand; (ii) microscopic root filling pull-out occurs; (iii) the cavity walls deform inwards, and (iv) occasionally delamination ensues, propagating out from the root canal filling along buried restoration-substrate interfaces. Our findings shed new light on the interactions between confined spaces and biomedical composites that cross-link in situ, highlighting the crucial role of geometry in channeling residual stresses. They further provide new insights into the emergence of structural flaws, calling attention to the need to find new treatment options. STATEMENT OF SIGNIFICANCE: This work quantifies recurring spatial and temporal material redistribution in composites used clinically to fill internal spaces in teeth. This knowledge is important for both promoting biomaterial resistance against potentially pathologic biofilms and for improving structural capacity to endure years of mechanical function. Our study demonstrates the significant role of geometry and the need for improved control over stress raisers to develop better treatment protocols and new space filling materials. The use of high-brilliance X-rays for time-lapse imaging at submicrometer resolution provides dynamic information about the damaging effects of stress relaxation due to polymerization shrinkage.

Development of dental inspection method: nondestructive evaluation of a dentin-adhesive interface by acoustic emission

PURPOSE

The state of adhesion between root dentin and a resin composite core material was inspected using acoustic emission (AE).

METHODS

A total of 14 human incisors and premolars were used to prepare "no-adhesive group" and "adhesive group" specimens. For "adhesive group" specimens, a bonding agent was applied to root canal dentin. The entire post space was subsequently filled with a resin composite for both specimen groups. The prepared specimens were fixed onto a jig on which an AE sensor was installed. A zirconia ball was used for the impact test, and a vibration wave generated by the collision was measured by the system using an AE sensor. The obtained data were subjected to time-frequency analysis using analysis software (LabVIEW), and the relationship between the amplitude indicating the loudness and the frequency indicating the sound component was analyzed.

RESULTS

Zirconia-ball collision tests using AE revealed differences between the groups with respect to the waveform of vibration waves transmitted to the root dentin through the root dentin-resin interface. The time-frequency analysis of the obtained data confirmed that multiple peaks were observed for each specimen in the no-adhesive group, whereas a single characteristic vibration peak was observed for all specimens in the adhesive group.

CONCLUSIONS

The state of the adhesive interface was successfully evaluated by AE. This demonstration is expected to lead to the development of a device that can detect problems at the bonding interface between the prostheses and tooth substances.

Optimization of Photopolymerization Process of Dental Composites

The aim of this paper is to perform optimization of photopolymerization process of dental composites in order to obtain maximum hardness. Samples (5 mm diameter; 2, 3 and 4 mm thickness) were made of Universal Composite (UC), Bulk fill Composite (BC) and Flowable Composite (FC). Light curing of specimens was performed with 600, 1000 and 1500 mW/cm2 light intensity and an irradiation time of 20, 40 and 60 s. Vickers microhardness on the top and bottom surfaces of samples was measured. Optimization was carried out via regression analysis using QStatLab software. Photopolymerization process parameters were calculated using a specially designed MatLab software-based algorithm. For all composites, regression models for hardness on top and bottom surfaces of composite layer were established. Layer thickness as well as hardness on top and bottom surfaces of each composite was calculated for 21 curing modes varying with light intensity and irradiation time. It was established that photopolymerization guidelines only of FC manufacturer guarantee the required hardness, while recommended regimes for UC and BC did not satisfy this requirement. Tables, containing recommended light curing regimes, were developed for three composite types, guaranteeing high hardness of composite restoration. They were designed to facilitate work of dentists in dental offices.

Shrinkage vectors in flowable bulk-fill and conventional composites: bulk versus incremental application

OBJECTIVES

Sufficient depth of cure allows bulk-fill composites to be placed with a 4-mm thickness. This study investigated bulk versus incremental application methods by visualizing shrinkage vectors in flowable bulk-fill and conventional composites.

MATERIALS AND METHODS

Cylindrical cavities (diameter = 6 mm, depth = 4 mm) were prepared in 24 teeth and then etched and bonded with OptiBond FL (Kerr, Italy). The composites were mixed with 2 wt% radiolucent glass beads. In one group, smart dentin replacement (SDR, Dentsply) was applied in bulk "SDR-bulk" (n = 8). In two groups, SDR and Tetric EvoFlow (Ivoclar Vivadent) were applied in two 2-mm-thick increments: "SDR-incremental" and "EvoFlow-incremental." Each material application was scanned with a micro-CT before and after light-curing (40 s, 1100 mW/cm²), and the shrinkage vectors were computed via image segmentation. Thereafter, linear polymerization shrinkage, shrinkage stress and gelation time were measured (n = 10).

RESULTS

The greatest shrinkage vectors were found in "SDR-bulk" and "SDR-increment2," and the smallest were found in "SDR-increment1-covered" and "EvoFlow-increment1-covered." Shrinkage away from and toward the cavity floor was greatest in "SDR-bulk" and "EvoFlow-increment2," respectively. The mean values of the shrinkage vectors were significantly different between groups (one-way ANOVA, Tamhane's T2 test, p < 0.05). The linear polymerization shrinkage and shrinkage stress were greatest in Tetric EvoFlow, and the gelation time was greatest in "SDR-bulk."

CONCLUSIONS

The bulk application method had greater values of shrinkage vectors and a higher debonding tendency at the cavity floor.

CLINICAL RELEVANCE

Incremental application remains the gold standard of composite insertion.

Polymerization Shrinkage Evaluation of Restorative Resin-Based Composites Using Fiber Bragg Grating Sensors

The purpose of this study was to compare the linear polymerization shrinkage of different restorative resin-based composites (RBCs) using fiber Bragg grating (FBG) sensors. Five RBCs were evaluated: Zirconfill^® (ZFL); Aura Bulk-Fill (ABF); Tetric^® N-Ceram Bulk-Fill (TBF); Filtek^TM Bulk-Fill (FBF); and Admira Fusion-Ormocer^® (ADF). Ten samples per resin were produced in standardized custom-made half-gutter silicone molds. Two optical FBG sensors were used to assess temperature and polymerization shrinkage. Light curing was performed for 40 s and polymerization shrinkage was evaluated at 5, 10, 40, 60, 150, and 300 s. Statistical analysis was accomplished for normal distribution (Shapiro-Wilk, p > 0.05). Two-way repeated measures ANOVA with Greenhouse-Geisser correction followed by Bonferroni′s post-hoc test was used to analyze the linear shrinkage data (p < 0.05). ZFL showed the highest linear shrinkage and ADF the lowest. Shrinkage increased for all RBCs until 300 s, where significant differences were found between ADF and all other resins (p < 0.05). Among bulk-fill RBCs, TBF showed the lowest shrinkage value, but not statistically different from FBF. The ADF presented lower linear shrinkage than all other RBCs, and restorative bulk-fill composites exhibited an intermediate behavior.

New Resins for Dental Composites

Restorative composites have evolved significantly since they were first introduced in the early 1960s, with most of the development concentrating on the filler technology. This has led to improved mechanical properties, notably wear resistance, and has expanded the use of composites to larger posterior restorations. On the organic matrix side, concerns over the polymerization stress and the potential damage to the bonded interface have dominated research in the past 20 y, with many "low-shrinkage" composites being launched commercially. The lack of clinical correlation between the use of these materials and improved restoration outcomes has shifted the focus more recently to improving materials' resistance to degradation in the oral environment, caused by aqueous solvents and salivary enzymes, as well as biofilm development. Antimicrobial and ester-free monomers have been developed in the recent past, and evidence is mounting for their potential benefit. This article reviews literature on the newest materials currently on the market and provides an outlook for the future developments needed to improve restoration longevity past the average 10 y.