Resin composite blocks for dental CAD/CAM applications reduce biofilm formation in vitro

Effect of surface roughness and biofilm formation on the color properties of resin-infiltrated ceramic and lithium disilicate glass-ceramic CAD-CAM materials

STATEMENT OF PROBLEM

Computer-aided design and computer-aided manufacturing (CAD-CAM) materials have become popular for dental restorations; however, which materials should be preferred in terms of surface properties after biofilm formation is unclear.

PURPOSE

The purpose of this in vitro study was to investigate the effect of biofilm formation on the discoloration properties of resin-infiltrated ceramic and glass-ceramic CAD-CAM materials and human teeth and to examine the effect of the brushing procedure on color change.

MATERIAL AND METHODS

One hundred and six 2-mm-thick specimens were prepared from IPS e.max CAD and Cerasmart, and a total of 53 intact human teeth were used. Five specimens from each group were used to measure the amount of live biomass in the biofilm. The remaining 48 specimens in each group were divided into 4 subgroups: kept in distilled water without the formation of dental biofilm (DW), kept in tea without the formation of dental biofilm (T), kept in distilled water after the formation of dental biofilm (DWB), and kept in tea after the formation of dental biofilm (TB) (n=12). After finishing and polishing the materials, initial color measurements were made using a spectrophotometer, and surface roughness measurements were made using noncontact profilometer. After creating a biofilm layer in DWB and TB, all specimens were kept in their solutions at 37 °C for 24 hours, and the color measurements were repeated. After the biofilm layer had been removed by brushing, a third color measurement was made. The data were statistically analyzed with one-way analysis of variance (ANOVA) and two-way ANOVA (α=.05).

RESULTS

The lowest roughness value was observed in Cerasmart. Tooth-IPS e.max CAD gave similar results. The Cerasmart material had the most viable biomass, whereas the IPS e.max CAD material had the least. TB had the highest ΔE1 value for all materials and DW had the lowest (P<.05). The brushing procedure caused the materials to return to their initial colors or reduce the color change in most groups.

CONCLUSIONS

The presence of biofilm on CAD-CAM materials immersed in distilled water caused an unacceptable degree of discoloration (ΔE>1.8), and immersion in tea led to greater color change. The adhesion of biofilm to restorative dental materials plays an important role in the coloring of these dental materials.

Clinical performance and wear resistance of milled resin composite material versus direct nanohybrid bulk-fill resin composite in the restoration of endodontically treated posterior teeth over 1 year: Randomized clinical trial

Context

The restorative complexities associated with endodontically treated teeth surpass those encountered with vital ones. The field of adhesive dentistry experienced a significant advancement that led to a shift in treatment approach toward bonded restorations.

Aim

The aim of the study was to assess the clinical performance of using indirect Milled composite or direct bulk-fill resin composite restorations for endo-treated teeth, as well as to measure the amount of wear on the occlusal tables of both restorations using a digital scanner.

Subjects and Methods

Participants were divided into two groups, where R1 represents the endodontically treated teeth restored with Milled composite, R2 represents the endodontically treated teeth restored with direct bulk-fill composite where 13 patients in each group were treated with a total number of 26 restorations in all patients. Where each restoration was assessed immediately at baseline (T0), 6 months (T6), and 12 months (T12) using the modified United States Public Health Service criteria. Moreover, wear was measured immediately at (T0) and (T12) intraorally and extraorally using intraoral scanners and three-dimensional surface-based superimposition software.

Statistical Analysis Used

Chi-squared test, Mann-Whitney U-test, Friedman's test, Nemenyi post hoc test, Shapiro-Wilk test, paired t-tests, intraclass correlation coefficient.

Results

At all intervals, the majority of the cases in both groups had an alpha score. Some cases exhibited bravo scores in both groups at T6 and T12 regarding the color match, marginal adaptation, marginal discoloration, and marginal integrity without statistically significant difference (P > 0.05). Direct nanohybrid bulk-fill resin composite showed a greater amount of wear without a statistically significant difference (P > 0.05). Extraoral measurement was significantly higher than intraoral measurement (P < 0.001). There was no significant reliability/agreement between both methods.

Conclusions

Both milled composite and direct bulk-fill resin composite restorations in endodontically treated teeth demonstrated appropriate clinical performance and minimal wear over an 1-year follow-up period.

Biofilm Formation on Hybrid, Resin-Based CAD/CAM Materials for Indirect Restorations: A Comprehensive Review

Hybrid materials are a recent addition in the field of restorative dentistry for computer-aided design/computer-aided manufacturing (CAD/CAM) indirect restorations. The long-term clinical success of modern dental restorative materials is influenced by multiple factors. Among the characteristics affecting the longevity of a restoration, the mechanical properties and physicοchemical interactions are of utmost importance. While numerous researchers constantly evaluate mechanical properties, the biological background of resin-based CAD/CAM biomaterials is scarcely investigated and, therefore, less described in the literature. This review aims to analyze biofilm formation on the surfaces of novel, hybrid, resin-based CAD/CAM materials and evaluate the methodological protocols followed to assess microbial growth. It is demonstrated that the surface structure, the composition and the finishing and polishing procedures on the surface of a dental restorative material influence initial bacterial adhesion; however, most studies focus on in vitro protocols, and in vivo and/or in situ research of microbiomics in CAD/CAM restorative materials is lacking, obstructing an accurate understanding of the bioadhesion phenomenon in the oral cavity.

Effect of tooth brushing simulation on the surface properties of various resin-matrix computer-aided design/computer-aided manufacturing ceramics

PURPOSE

The purpose was to investigate the alterations in surface properties of different resin-matrix CAD/CAM ceramics following tooth brushing simulation (TBS) and compare them with a direct resin composite and a glass ceramic CAD/CAM material.

MATERIALS AND METHODS

Four resin-based CAD/CAM restoratives (Brilliant Crios-BR, Lava™ Ultimate-LV, Grandio Blocs-GR and Shofu Block HC-SH), a leucite-reinforced glass ceramic (IPS Empress® CAD-EC) and a resin composite (Filtek™ Z250-FZ) for direct restorations were tested. In particular, surface loss, hardness, roughness and morphology were investigated utilizing confocal microscopy, scanning electron microscopy and nanoindentation tester. TBS was conducted for 4 × 15 min on the surface of the samples and then the changes in their surface properties were evaluated.

RESULTS

After TBS, all the experimental groups exhibited surface loss to different extent. FZ and BR presented the highest surface loss, while EC and GR the lowest (p < 0.05). Regarding surface roughness, all the tested materials exhibited increase after TBS (p < 0.05), except LV (p = 0.099). EC presented the lowest Sa values, while FZ and BR the highest (p < 0.05). Changes in surface morphology were in compliance with the results of surface roughness and also surface hardness was correlated with surface loss.

CONCLUSIONS

The tested resin-matrix CAD/CAM ceramic restorative materials showed a competent behavior against abrasive forces applied during TBS. Surface loss and roughness changes were material dependent and superior compared to a resin composite for direct restorations, while in comparison with a leucite-reinforced glass ceramic exhibited inferior properties.

CLINICAL SIGNIFICANCE

Tooth brushing affected differently the surface of the tested restorative materials. However, the abrasive wear that was induced was negligible. Clinical studies are necessary to ascertain if there is clinical significance of these surface alterations that may demand repair of such restorations.

Effect of different finishing and polishing procedures on surface roughness and microbial adhesion on highly-filled composites for injectable mold technique

OBJECTIVE

To evaluate the effect of different finishing and polishing procedures on surface roughness and microbial adhesion and viability of Streptococcus mutans on novel highly-filled composites for injectable mold technique.

MATERIALS AND METHODS

One hundred sixty specimens were divided into four material groups: FSF (Filtek Supreme Flowable Restorative), TE (Tetric EvoFlow), GUI (G-aenial Universal Injectable) and GUF (G-aenial Universal Flo). Within each group, specimens were split regarding finishing and polishing (F/P) procedures into: SLD (Sof-Lex Discs), SLS (Sof-Lex Spirals), OG (OneGloss) and PG (PoGo). Surface roughness was analyzed using profilometer (Ra and Rz) and scanning electron microscopy (SEM) and Strep. mutans biofilm formation was analyzed using colony forming unit (CFU) and cell viability assay. Two-way analysis of variance (ANOVA) followed by Tukey's post hoc test were used for comparison among groups, Pearson's coefficient was applied for the correlation between Ra and CFU/ml and all data were presented as mean ± SD.

RESULTS

Both materials and F/P procedures affect Ra, Rz and Strep. mutans CFU/ml values (p ≤ 0.05). Considering the Ra and Rz, GUI and GUF revealed lower values, compared to FSF and TE and SLD and SLS revealed lower values, compared to OG and PG. Considering the Strep. mutans CFU/ml and viability, GUI and TE presented lower values, compared to GUF and FSF and SLD and SLS presented lower values, compared to OG and PG. Moderate positive correlation was found between Ra and CFU/ml (r = 0.552).

CONCLUSIONS

The smoothest surfaces possess GUI and GUF, among materials and SLD and SLS, among F/P procedures. GUI adhered the lowest amount of Strep. mutans, due to the smoothest surfaces. FSF and GUF revealed the highest amount of Strep. mutans, due to bis-GMA, bis-MEPP and TEGDMA in their composition.

CLINICAL SIGNIFICANCE

The findings of the present study may be beneficial for the proper selection of highly-filled composites and an adequate finishing and polishing procedure when performing the injectable mold composite resin veneer technique.

Shade, Aging and Spatial-Dependent Variation of Elastoplastic and Viscoelastic Characteristics in a Dental, Submicron Hybrid CAD/CAM Composite

This article reports the elastoplastic and viscoelastic response of an industrially cured CAD/CAM resin-based composite (Brilliant Crios, Coltene) at different scales, spatial locations, aging conditions, and shading. Mechanical tests were performed at the macroscopic scale to investigate material strength, elastic modulus, fracture mechanisms and reliability. An instrumented indentation test (IIT) was performed at the microscopic level in a quasi-static mode to assess the elastic and plastic deformation upon indentation, either by mapping transverse areas of the CAD/CAM block or at randomly selected locations. A dynamic-mechanical analysis was then carried out, in which chewing-relevant frequencies were included (0.5 to 5 Hz). Characteristics measured at the nano- and micro-scale were more discriminative in identifying the impact of variables as those measured at macro scale. Anisotropy as a function of the spatial location was identified in all shades, with gradual variation in properties from the center of the block to peripheral locations. Depending on the scale of observation, differences in shade and translucency are very small or not statistically significant. The aging effect is classified as low, but measurable on all scales, with the same pattern of variation occurring in all shades. Aging affects plastic deformation more than elastic deformation and affects elastic deformation more than viscous deformation.

Evaluation of Physical-Chemical Properties of Contemporary CAD/CAM Materials with Chromatic Transition "Multicolor"

The use of materials for computer-aided design/computer-aided manufacturing (CAD/CAM) has been rapidly increasing in daily practice. However, one of the main issues regarding modern CAD/CAM materials is their aging in the oral environment, which may lead to significant changes in their overall properties. The aim of this study was to compare the flexural strength, water sorption, cross-link density (softening ratio%), surface roughness, and SEM analysis of three modern CAD/CAM "multicolor" composites. Grandio (Grandio disc multicolor-VOCO GmbH, Cuxhaven, Germany), Shofu (Shofu Block HC-Shofu Inc., Kyoto, Japan), and Vita (Vita Enamic multiColor-Vita Zahnfabrik, Bad Sackingen, Germany) were tested in this study. They were prepared in stick-shaped specimens and submitted to different tests after several aging protocols, such as thermocycling and mechanical cycle loading challenge. Further disc-shaped specimens were also created and tested for water sorption, cross-link density, surface roughness, and SEM ultramorphology, before and after storage in an ethanol-based solution. For flexural strength and ultimate tensile strength, Grandio showed the greatest values both at baseline and after aging (p < 0.05). Grandio and Vita Enamic presented the highest modulus of elasticity and the lowest water sorption (p < 0.05). A significant reduction (p < 0.05) in microhardness after ethanol storage (softening ratio%) was observed especially in Shofu. Grandio had the lowest roughness parameters compared to the other tested CAD/CAM materials, while ethanol storage significantly increased the Ra and RSm values in Shofu (p < 0.05). Despite the comparable modulus of elasticity of Vita and Grandio, this latter showed greater flexural strength and ultimate tensile strength both at baseline and after aging. Hence, Grandio and Vita Enamic may be employed for the anterior teeth and for those restorations requiring load-bearing capacity. Conversely, aging seems to affect several properties of Shofu, so its use for permanent restorations should be well-pondered based on the clinical situation.

Biofilm Formation on the Surfaces of CAD/CAM Dental Polymers

Dental polymers are now available as monolithic materials which can be readily used in computer-aided design and computer-aided manufacturing (CAD/CAM) systems. Despite possessing numerous advantages over conventionally produced polymers, the polymers produced by either of these systems fail to exhibit immunity to surface microbial adhesion when introduced into the oral environment, leading to the development of oral diseases. The aim of this study was to analyze the biofilm formation of six microorganisms from the oral cavity and its correlation to the surface characteristics of CAD/CAM dental polymers. A total of ninety specimens were divided into three groups: resin-based composite, polymethyl methacrylate, and polyether ether ketone. The experimental procedure included surface roughness and water contact angle measurements, colony forming unit counting, and scanning electron microscopy analysis of biofilm formed on the surface of the tested materials. The data were analyzed using the Kruskal-Wallis test, with a Dunn's post hoc analysis, and one way analysis of variance, with a Tukey's post hoc test; the correlation between the measurements was tested using Spearman's correlation coefficient, and descriptive statistics were used to present the data. Despite using the same manufacturing procedure, as well as the identical manufacturer's finishing and polishing protocols, CAD/CAM dental polymers revealed significant differences in surface roughness and water contact angle, and the increased values of both parameters led to an increase in biofilm formation on the surface of the materials. The CAD/CAM resin-based composite showed the lowest number of adhered microorganisms compared to CAD/CAM polymethyl methacrylate and CAD/CAM polyether ether ketone.

The influence of different storage media on Vickers hardness and surface roughness of CAD/CAM resin composites

INTRODUCTION

This study examined Vickers hardness as well as surface characteristics of different computer-aided design/computer-aided manufacturing (CAD/CAM) resin composites prior to and after storage in various media.

MATERIALS AND METHODS

CAD/CAM resin composite blocks (Grandio Blocs (GB), Lava Ultimate (LU), Brilliant Crios (BC), Cerasmart (GC), Shofu Block HC (SB), Tetric CAD (TC), Luxacam Composite (LC); incl. different translucency variants) were prepared, polished and surface free energy was determined. The specimens were divided into four groups: dry conditions for 24 h (25 °C), demineralized water (37 °C), Pepsi Cola (37 °C) and 75% ethanol (37 °C). After seven and 28 days of storage, Vickers hardness was determined. Surface roughness was measured after the entire storage period.

RESULTS AND DISCUSSION

Vickers hardness was in the range of about 150 HV for GB, around 115 HV for LU, and 80-100 HV for BC, GC, SB, TC and LC. Only minor differences (total: 50.2 (6.4)-56.2 (3.2) mN/m) in surface free energy could be detected. No relationship was observed between surface free energy and filler content. However, a correlation between filler content and Vickers hardness was evident. Artificial aging caused a decrease of Vickers hardness (up to -40 HV or 35%) depending on storage media, duration and material. The changes in surface texture after immersion in different media were below a value of ΔSa = 0.015 µm.

CONCLUSION

Artificial aging of CAD/CAM resin composites leads to a significant decrease of Vickers hardness for most materials, while only small changes in surface roughness were identified.

Bacterial Adhesion on Dental Polymers as a Function of Manufacturing Techniques

The microbiological behavior of dental polymer materials is crucial to secure the clinical success of dental restorations. Here, the manufacturing process and the machining can play a decisive role. This study investigated the bacterial adhesion on dental polymers as a function of manufacturing techniques (additive/subtractive) and different polishing protocols. Specimens were made from polyaryletherketone (PEEK, PEKK, and AKP), resin-based CAD/CAM materials (composite and PMMA), and printed methacrylate (MA)-based materials. Surface roughness (R_z; R_a) was determined using a laser scanning microscope, and SFE/contact angles were measured using the sessile drop method. After salivary pellicle formation, in vitro biofilm formation was initiated by exposing the specimens to suspensions of Streptococcus mutans (S. mutans) and Streptococcus sanguinis (S. sanguinis). Adherent bacteria were quantified using a fluorometric assay. One-way ANOVA analysis found significant influences (p < 0.001) for the individual parameters (treatment and material) and their combinations for both types of bacteria. Stronger polishing led to significantly (p < 0.001) less adhesion of S. sanguinis (Pearson correlation PC = -0.240) and S. mutans (PC = -0.206). A highly significant (p = 0.010, PC = 0.135) correlation between S. sanguinis adhesion and R_z was identified. Post hoc analysis revealed significant higher bacterial adhesion for vertically printed MA specimens compared to horizontally printed specimens. Furthermore, significant higher adhesion of S. sanguinis on pressed PEEK was revealed comparing to the other manufacturing methods (milling, injection molding, and 3D printing). The milled PAEK samples showed similar bacterial adhesion. In general, the resin-based materials, composites, and PAEKs showed different bacterial adhesion. Fabrication methods were shown to play a critical role; the pressed PEEK showed the highest initial accumulations. Horizontal DLP fabrication reduced bacterial adhesion. Roughness < 10 µm or polishing appear to be essential for reducing bacterial adhesion.

Physical-chemical and microbiological performances of graphene-doped PMMA for CAD/CAM applications before and after accelerated aging protocols

OBJECTIVES

Innovative, nanotechnologies-featuring dental materials for CAD/CAM applications are becoming available. However, the interaction with the oral environment poses critical challenges to their longevity. The present study evaluated specific physical-chemical properties and antimicrobial potential of a CAD/CAM graphene-doped resin before and after accelerated aging protocols.

METHODS

Graphene nanofibers (GNF)-doped (<50 ppm) PMMA (GPMMA) and control PMMA CAD/CAM discs were used. Specimens underwent aging procedures of their bulk (thermo- and load-cycling) and surface (24 h-immersion in absolute ethanol), then they were tested for flexural strength, ultimate tensile strength, sorption/solubility, and methyl-methacrylate elution. Surface characterization included x-ray diffraction, Fourier-transform infrared spectroscopy, X-ray photoelectron spectroscopy, surface roughness, microhardness, and scanning electron microscopy (SEM). Adherence of Streptococcus mutans and Candida albicans, and biofilm formation (continuous-flow bioreactor) by the same strains and an artificial oral microcosm were investigated.

RESULTS

GNF-doping improved the physical-chemical bulk properties of the PMMA resin. Surface aging reduced microhardness and increased the roughness of both test and control materials. Surfaces displayed signs of swelling and degradation at SEM. Microbiological data of non-aged surfaces showed that GNF-doping significantly reduced biofilm formation by all tested strains despite having no impact on microbial adherence. After aging, microbial adherence was higher on GPMMA surfaces, while biofilm formation was not promoted.

SIGNIFICANCE

GNF-doping improved the material's performance and influenced its antimicrobial potential. This strategy seems a valuable option to overcome the effects of surface degradation induced by aging on the antimicrobial potential of PMMA resin.

Influence of Artificial Aging on Mechanical Properties of Six Resin Composite Blocks for CAD/CAM Application

(1) The interactions in the oral cavity between resin composite blocks for CAD/CAM application and saliva, biofilm, and chemicals and their influence on mechanical properties are still mostly unknown. The purpose of this study is to examine the impact of artificial aging on the flexural strength, flexural modulus, hardness, Weibull modulus, and probability of failure of six resin composite CAD/CAM materials. (2) The aging was conducted by storing the specimens in water at 37 °C for 3 months, then a 3-point bending test was applied and measured. The microhardness was measured with a Vickers microhardness tester. Weibull analysis (according to ISO) was also performed. The shape and scale parameters were calculated. (3) After aging, the flexural strength values ranged from 95.51 (SD 9.07) MPa for the aged Shofu Block HC (HC) to 160.28 (SD 10.37) MPa for non-aged Gandio blocks (GR), and the flexural modulus values ranged from 7.75 (SD 0.19) GPa for HC to 16.77 (SD 0.60) GPa for GR. The microhardness (HV01) ranged from 72.71 (SD 1.43) for the Katana Avencia Block (AV) to 140.50 (SD 5.51) for GR. After aging, the Weibull characteristic strength ranged from 99.47 MPa for HC to 169.25 MPA for Brilliant Crios (CR). (4) Water storage led to a decrease in flexural strength and characteristic strength and slightly affected the flexural modulus. Gandio Blocks, Tetric CAD, and Brilliant Crios presented higher flexural strength than others.

Effect of different polishing techniques on surface properties and bacterial adhesion on resin-ceramic CAD/CAM materials

OBJECTIVES

The aim of this study is to evaluate the adhesion of Streptococcus mutans on the surface of CAD/CAM materials with various surface treatments.

METHODS

Vita Enamic, Lava Ultimate, and Cerasmart materials were used in this study. A total of 90 samples were prepared (n = 10). After various finishing and polishing procedures (non-polished, manual polished, and glazed), surface roughness (SR) measurements, surface free energy (SFE), and elemental and topographic analysis with FIB-SEM/EDX were used to evaluate the samples' surface properties. To improve bacterial adhesion, CAD/CAM materials were covered with sterile artificial saliva containing mucin for pellicle formation and incubated for 1 h at 37 °C. Bacteria were then inoculated into the pellicle-coated specimens, and incubation was performed at 37 °C for 24 h. Bacterial adhesion was determined as × 10⁵ CFU/mL and monitored using FIB-SEM analysis. The Kolmogorov-Smirnov test was used to statistically analyze the normality of the distribution; the groups were then compared using one-way ANOVA and Tukey's test.

RESULTS

The SR of the control group was statistically higher in all materials (p < 0.05). There were no statistically significant differences in SR between all materials in the non-polished and manual polished groups (p > 0.05). The Vita Enamic control group exhibited the highest SFE value. The highest S. mutans adhesion was observed in non-polished (p < 0.05). Vita Enamic samples had higher CFU than other groups.

CONCLUSIONS

Non-polished surfaces showed higher SR and bacterial adhesion. Polishing processes affected the surface properties and bacterial adhesion.

CLINICAL RELEVANCE

Care must be taken in polishing restorations to minimize the risk of bacterial adhesion and recurrent caries.

TRIAL REGISTRATION

In this study, the materials used for dental treatments are in vitro evaluated. Due to that, this study is not registered to clinical trials.

Influence of different zirconia surface treatments on biofilm formation in vitro and in situ

OBJECTIVES

To determine if the surface treatment of zirconia affects biofilm formation in an in vitro three-species biofilm model and in situ.

MATERIAL AND METHODS

Zirconia surfaces considered for the transmucosal portion of a zirconia implant were compared with polished pure titanium grade 4 (Tp). Discs 13 mm in diameter of either polished (Zp), polished and heat-treated (Zpt), machined (Zm), machined and heat-treated (Zmt) and sandblasted, etched and heat-treated (Z14) zirconia were fabricated. Surface roughness and wettability of specimens was measured. Biofilm formation was evaluated by safranin staining and scanning electron microscopy (SEM) using a three-species model, and intraorally with 16 volunteers carrying oral splints in two independent experiments. Relative biofilm formation was compared with Kruskal-Wallis followed by Bonferroni post-hoc test (α=0.05).

RESULTS

In vitro biofilm formation with optical density values on Zp (0.14±0.01), Zpt (0.14±0.02), Zm (0.13±0.01) and Zmt (0.13±0.01) was significantly lower than on Tp (0.21±0.05) and Z14 (0.20±0.04) (p<0.05). In situ biofilm formation was significantly higher on Z14 (0.56±0.45) (p<0.05), while no significant differences in optical density were observed among Zp (0.25±0.20), Zm (0.36±0.34) and Tp (0.28±0.22). SEM analysis supported quantitative findings.

CONCLUSIONS

In the in vitro three-species biofilm model differences in material and surface roughness affected biofilm formation. In situ biofilm formation was mainly affected by the surface roughness of the specimens. Polishing of zirconia is recommended to reduce biofilm formation while heat-treatment has no significant effect.

Surface Modification to Modulate Microbial Biofilms-Applications in Dental Medicine

Recent progress in materials science and nanotechnology has led to the development of advanced materials with multifunctional properties. Dental medicine has benefited from the design of such materials and coatings in providing patients with tailored implants and improved materials for restorative and functional use. Such materials and coatings allow for better acceptance by the host body, promote successful implantation and determine a reduced inflammatory response after contact with the materials. Since numerous dental pathologies are influenced by the presence and activity of some pathogenic microorganisms, novel materials are needed to overcome this challenge as well. This paper aimed to reveal and discuss the most recent and innovative progress made in the field of materials surface modification in terms of microbial attachment inhibition and biofilm formation, with a direct impact on dental medicine.

CAD/CAM Resin-Based Composites for Use in Long-Term Temporary Fixed Dental Prostheses

The aim of this in vitro study was to analyse the performance of CAD/CAM resin-based composites for the fabrication of long-term temporary fixed dental prostheses (FDP) and to compare it to other commercially available alternative materials regarding its long-term stability. Four CAD/CAM materials [Structur CAD (SC), VITA CAD-Temp (CT), Grandio disc (GD), and Lava Esthetic (LE)] and two direct RBCs [(Structur 3 (S3) and LuxaCrown (LC)] were used to fabricate three-unit FDPs. 10/20 FDPs were subjected to thermal cycling and mechanical loading by chewing simulation and 10/20 FDPs were stored in distilled water. Two FDPs of each material were forwarded to additional image diagnostics prior and after chewing simulation. Fracture loads were measured and data were statistically analysed. SC is suitable for use as a long-term temporary (two years) three-unit FDP. In comparison to CT, SC featured significantly higher breaking forces (SC > 800 N; CT < 600 N) and the surface wear of the antagonists was (significantly) lower and the abrasion of the FDP was similar. The high breaking forces (1100–1327 N) of GD and the small difference compared to LE regarding flexural strength showed that the material might be used for the fabrication of three-unit FDPs. With the exception of S3, all analysed direct or indirect materials are suitable for the fabrication of temporary FDPs.

Influence of Curing Time on the Microbiological Behavior of Bulk-Fill Nanohybrid Resin Composites

This in vitro study aimed to evaluate the influence of curing time on surface characteristics and microbiological behavior of three bulk-fill resin-based composites (RBCs). Materials were light-cured for either 10 s or 80 s, then finished using a standard clinical procedure. They were characterized by surface morphology (SEM), surface elemental composition (EDS), surface roughness (SR), and surface free energy (SFE). Microbiological behavior was assessed as S. mutans adherence (2 h) and biofilm formation (24 h) using a continuous-flow bioreactor. Statistical analysis included a two-way ANOVA and Tukey’s test (p < 0.05). Materials differed substantially as filler shape, dimension, elemental composition and resin matrix composition. Significant differences between materials were found for SR, SFE, and microbiological behavior. Such differences were less pronounced or disappeared after prolonged photocuring. The latter yielded significantly lower adherence and biofilm formation on all tested materials, similar to conventional RBCs. Improved photoinitiators and UDMA-based resin matrix composition may explain these results. No correlation between surface characteristics and microbiological behavior can explain the similar microbiological behavior of bulk-fill materials after prolonged photocuring. This different performance of bulk-fill materials compared with conventional RBCs, where surface characteristics, especially surface chemistry, influence microbiological behavior, may have important implications for secondary caries occurrence and restoration longevity.

Influence of Low-pH Beverages on the Two-Body Wear of CAD/CAM Monolithic Materials

The aim of this in vitro study is to evaluate the effect of different acidic media on volumetric wear and surface roughness of CAD/CAM monolithic materials. Forty-eight rectangular specimens were prepared using different CAD/CAM monolithic materials: nanohybrid composite (Grandio Blocks, Voco), resin-based composite (Cerasmart, GC), lithium disilicate (E-Max, Ivoclar), and high-translucency zirconia (Katana STML, Kuraray Noritake). After storage in distilled water at 37 °C for two days, the specimens were tested using a chewing machine with a stainless-steel ball as an antagonist (49N loads, 250,000 cycles). Testing was performed using distilled water, Coca-Cola, and Red Bull as abrasive media. Wear and surface roughness analyses of the CAD/CAM materials were performed using a 3D profilometer and analyzed with two-way analysis of variance and post hoc pairwise comparison procedures. Worn surfaces were examined using scanning electron microscopy. Resin-based materials suffered higher volumetric wear than ceramics (p = 0.00001). Water induced significantly less volumetric wear than the other tested solutions (p = 0.0014), independent of the material tested. High-translucency zirconia showed less surface roughness than all the other materials tested. The selection of monolithic CAD/CAM materials to restore worn dentition due to erosive processes could impact restorative therapy stability over time. Resin-based materials seem to be more influenced by the acidic environment when subjected to a two-body wear test.

Influence of the Manufacturing Method on the Adhesion of Candida albicans and Streptococcus mutans to Oral Splint Resins

Microbial adhesion to oral splints may lead to oral diseases such as candidiasis, periodontitis or caries. The present in vitro study aimed to assess the effect of novel computer-aided design/computer-aided manufacturing (CAD/CAM) and conventional manufacturing on Candida albicans and Streptococcus mutans adhesion to oral splint resins. Standardized specimens of four 3D-printed, two milled, one thermoformed and one pressed splint resin were assessed for surface roughness by widefield confocal microscopy and for surface free energy by contact angle measurements. Specimens were incubated with C. albicans or S. mutans for two hours; a luminometric ATP assay was performed for the quantification of fungal and bacterial adhesion. Both one-way ANOVA with Tukey post hoc testing and Pearson correlation analysis were performed (p < 0.05) in order to relate manufacturing methods, surface roughness and surface free energy to microbial adhesion. Three-dimensional printing and milling were associated with increased adhesion of C. albicans compared to conventional thermoforming and pressing, while the S. mutans adhesion was not affected. Surface roughness and surface free energy showed no significant correlation with microbial adhesion. Increased fungal adhesion to oral splints manufactured by 3D printing or milling may be relevant for medically compromised patients with an enhanced risk for developing candidiasis.

Characterisation of the Filler Fraction in CAD/CAM Resin-Based Composites

The performance of dental resin-based composites (RBCs) heavily depends on the characteristic properties of the individual filler fraction. As specific information regarding the properties of the filler fraction is often missing, the current study aims to characterize the filler fractions of several contemporary computer-aided design/computer-aided manufacturing (CAD/CAM) RBCs from a material science point of view. The filler fractions of seven commercially available CAD/CAM RBCs featuring different translucency variants were analysed using Scanning Electron Microscopy (SEM) with Energy Dispersive X-ray Spectroscopy (EDS), Micro-X-ray Computed Tomography (µXCT), Thermogravimetric Analysis (TG) and X-ray Diffractometry (XRD). All CAD/CAM RBCs investigated included midifill hybrid type filler fractions, and the size of the individual particles was clearly larger than the individual specifications of the manufacturer. The fillers in Shofu Block HC featured a sphericity of ≈0.8, while it was <0.7 in all other RBCs. All RBCs featured only X-ray amorphous phases. However, in Lava Ultimate, zircon crystals with low crystallinity were detected. In some CAD/CAM RBCs, inhomogeneities (X-ray opaque fillers or pores) with a size <80 µm were identified, but the effects were minor in relation to the total volume (<0.01 vol.%). The characteristic parameters of the filler fraction in RBCs are essential for the interpretation of the individual material's mechanical and optical properties.

Frequency-related viscoelastic properties in high translucent CAD-CAM resin-based composites

OBJECTIVE

The study aims to quantify the viscoelastic properties of representative dental CAD/CAM resin-based composites (RBC) and to determine the effects of loading frequencies on the viscoelastic material response in comparison to clinically established CAD/CAM glass ceramics.

METHODS

Eight RBCs, one leucite-reinforced, and one lithium disilicate glass-ceramics were selected. The quasi-static (indentation hardness H_IT, indentation modulus, E_IT) and viscoelastic (storage modulus E', loss modulus E″, loss factor tan δ) material behavior was monitored by a depth-sensing indentation test equipped with a DMA module. A low-magnitude oscillating force was therefore superimposed onto a quasi-static force (F_max = 1000 mN) at 20 different frequencies in the range 1-50 Hz. One and multiple-way analysis of variance (ANOVA), the Tukey honestly significant difference (HSD) post-hoc tests (α = 0.05), and a Pearson correlation analysis were used for data analysis.

RESULTS

The quasi-static parameters increased with the crystalline phase in glass ceramics and with the amount of inorganic filler in RBCs. The tan δ, which is related to the damping capacity of a material, increased with the increasing amount of glass phase in glass ceramics or with the amount of organic phase in RBCs. A pronounced influence of the frequency on the measured parameters and their patterns of variation was observed. H_IT was up to ten time higher in glass ceramics compared to RBCs and highest at the lowest frequency (1 Hz). Parameters E_IT and E' differ less and were lowest at the lowest frequency. E″ distinguished three different patterns of variation with frequency. The tan δ decreased rapidly with frequency in glass ceramics, while the decrease in RBCs was gradually. Frequency influenced stronger tan δ (p < 0.001, η_P² = 0.85), followed by E' (p < 0.001, η_P² = 0.773), E_IT (p < 0.001, η_P² = 0.772), and E″ (p < 0.001, η_P² = 0.714), and less H_IT (p < 0.001, η_P² = 0.384).

CONCLUSIONS

All materials sowed viscoelastic behavior related to their microstructure and the internal friction created by grain or interphase boundary relaxation. RBCs have better damping capabilities over a wider frequency range. The deviations from the ideal elasticity were significantly lower in the glass ceramics than in the RBCs.

Tooth-Colored CAD/CAM Materials for Application in 3-Unit Fixed Dental Prostheses in the Molar Area: An Illustrated Clinical Comparison

The aim of this study was to compare the clinical properties of tooth-colored computer-aided design/computer-aided manufacturing (CAD/CAM) materials for the fabrication of a 3-unit fixed dental prostheses (FDPs) in the same clinical scenario. A 53-year-old female patient was supplied with a 3-unit FDP to replace a second premolar in the upper jaw. Restorations were fabricated from 3 mol%, 4 mol%, and 5 mol% yttrium oxide zirconia, zirconia with translucency gradient, indirect composite resin, polyetheretherketone (PEEK), and polyetherketoneketone (PEKK). Milling time, weight, and radiopacity were investigated. Esthetics were examined following the US Public Health Service criteria (USPHS). The milling time for zirconia was twice as high as for the indirect composite resin, PEEK, or PEKK. The latter materials had a weight of 2 g each, while zirconia restorations yielded 5 g. Zirconia presented intense radiopacity. PEEK and PEKK required veneering and an opaquer was applied to the PEKK framework. All FDPs showed acceptable esthetics. PEEK and PEKK restorations were featured by a grayish shimmering. A variety of CAD/CAM materials are available to fabricate 3-unit FDPs with esthetically acceptable results. In the esthetic zone, PEEK and PEKK require veneering and an opaquer might be applied. Milling time, weight, and radiopacity were relatively high for zirconia FDPs.

Spatial Distribution of the Micro-Mechanical Properties in High-Translucent CAD/CAM Resin-Composite Blocks

Industrially cured, high-translucent computer-aided design/computer-aided manufacturing (CAD/CAM) resin-based composites (RBC) are the most recently launched dental restoratives. Clinical treatments and laboratory tests are based on a homogeneous distribution of properties within CAD/CAM blocks to obtain constant and reproducible results. The study therefore aims to determine the spatial distribution of various micro-mechanical parameters (Vickers hardness, Martens hardness, indentation modulus, creep, elastic and total indentation work) in five representative CAD/CAM RBCs. The properties of the tooth structure were evaluated under similar conditions. Filler size and shape were analyzed by scanning electron microscopy. A multivariate analysis (general linear model) identified a very strong influence of the material on all measured properties (p < 0.001; partial eta squared η_P² > 0.943), whereby the most sensitive parameters when identifying differences within regions were the indentation modulus and the elastic indentation work. CAD/CAM RBC blocks show gradually varying properties that can increase or decrease from central to peripheral areas regardless of the chemical composition of the materials or the inorganic filler fraction. The degree of variation in the measured properties is material-specific and less than 8.7%. Clinical applications and in vitro study designs should consider slight inhomogeneity in CAD/CAM RBC blocks, while the location of the regions with best mechanical performance depends on the material.