Experimental and FE displacement and polymerization stress of bonded restorations as a function of the C-Factor, volume and substrate stiffness

Comparison of the stress distribution in base materials and thicknesses in composite resin restorations

Resin-based composite materials are commonly used for restorations, but their dimensional changes during the polymerization could cause various clinical problems. This study evaluated the influence of a base of different materials and thicknesses on the stress magnitude and distribution in a second maxillary premolar with an MOD resin composite restoration using three-dimensional finite element analysis. A sound tooth without cavity was considered as the control group (ST), and another group was restored with composite resin without applying a base material in a MOD cavity (CR). The other three groups were restored with composite resin along with the following base materials: glass ionomer cement, low-viscosity resin, and tricalcium silicate, respectively (CR-GIC, CR-LR, and CR-TS). These three groups were further divided into two subgroups according to the thickness of the base layer: thin (0.5 mm) and thick (1.0 mm). The stress distribution was compared using the maximum principal stress after polymerization shrinkage and vertical loading with 600 N on the occlusal surface. Group ST showed the lowest stress value, and its stress propagation was confined to outer enamel surfaces only. Group CR demonstrated the highest stress distribution in the tooth-restoration interface with increased failure risk on marginal areas. The thin and thick subgroups of the three groups with a base layer had lower stress levels than Group CR. The base materials reduced the marginal stress caused by polymerization shrinkage of composite resin in MOD cavities. Different base materials and thicknesses did not affect the stress distribution.

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.

A novel resin cement to improve bonding interface durability

Bonding failure is one of the main causes of failure of dental restorations. The bonding strength, aging resistance, and polymerization shrinkage of cement can affect the stability of the bonding interface and lead to marginal microleakage. To reduce the bonding failure rate of restorations, a novel polyurethane (PU) cement was designed to improve the mechanical properties, hydrophobicity, degree of conversion (DC), polymerization shrinkage, bond strength and aging resistance of cement by introducing isophorone diisocyanate (IPDI) and hydroxyethyl methacrylate (HEMA) and adjusting the polyester : polyether ratio to increase the degree of cross-linking. Experimental results verified that the novel PU could increase the mechanical properties and thermal stability of the cement, reduce polymerization shrinkage during the curing reaction, improve the bonding performance and DC, endow the cement with hydrophobic properties, and improve its ability to resist aging in the salivary environment to maintain the long-term stability of interfacial bonding under the influence of comprehensive factors. The results of this study provide a new direction and insights to reduce microleakage and improve the success rate of restorations.

Bonding failure is one of the main causes of failure of dental restorations.

Do dual-cure bulk-fill resin composites reduce gaps and improve depth of cure

This in vitro study aimed to evaluate the gaps length and depth of cure of dual-cure bulk-fill resin composites inserted in box-shaped preparations. Box-shaped preparations (4 mm deep) were made in fifteen human third-molars and divided into three groups according to the resin composites (n=5): Dual-cure bulk-fill BulkEZ (BEZ); Dual-cure bulk-fill HyperFIL (HF); and Tetric Evoceram Bulk-fill (TETRIC), as control. Gaps length (%) was evaluated in tooth-restoration interface with micro-computed tomography (µCT). The restorations were sectioned, and the degree of conversion (DC) and Knoop microhardness were evaluated at five depths (0.3, 1, 2, 3, and 4 mm). Microhardness data were statistically evaluated using absolute values (KHN) and relative values (microhardness percentages in relation to top). Gaps length (%) increased in the following order: BEZ=TETRIC<HF. The microhardness percentages in relation to top significantly decreased from 2 mm for TETRIC and 3 mm for HF. BEZ had constant microhardness and DC at all depths, while HF and TETRIC presented a significant decrease on DC at 4 mm. Dual-cure bulk-fill composites did not reduce gaps compared to light-cure bulk-fill, but they can improve depth of cure of bulk-filled restorations.

Polymerization Stress and Gap Formation of Self-adhesive, Bulk-fill and Flowable Composite Resins

CLINICAL RELEVANCE

Bulk-fill materials show a similar or better performance than control flowable materials regarding interfacial integrity. However, some self-adhesive composites need improvements to achieve competitive performance.

SUMMARY

Objective: This laboratory study compared the polymerization stress and gap formation of self-adhesive, bulk-fill and control flowable composites. The degree of conversion (DC) and post-gel shrinkage were also assessed.Methods: Two self-adhesive (Vertise Flow and Fusio Liquid Dentin), two bulk-fill (Tetric N-Flow Bulk-Fill and Filtek Bulk-Fill Flowable Restorative), and two control flowable (Z350 XT Flowable Restorative and Tetric N-Flow) composites were evaluated. Polymerization stress (PS) was determined in a universal testing machine (n=5). Gap formation was evaluated by scanning electron microscopy in class I restorations (n=6). DC was measured by Fourier transform infrared spectroscopy (n=3). Post-gel volumetric shrinkage (VS) was measured using the strain gauge method (n=5). Data were submitted to one-way analysis of variance or a Kruskal-Wallis test (α=0.05).Results: Vertise Flow and Fusio Liquid Dentin presented the highest interfacial gap (27%±5% and 21%±6%, respectively), which was associated with their highest PS (4.1±0.8 MPa and 3.5±0.6 MPa, respectively) and DC (63%±2% and 60%±2%, respectively) in spite of the lowest VS (1.0%±0.2% and 1.0%±0.3%, respectively). Tetric N-Flow Bulk-Fill and Filtek Bulk-Fill Flowable Restorative presented similar PS (2.9± 0.3 MPa and 2.4±0.2 MPa, respectively) to both control materials. However, the Tetric N-Flow Bulk-Fill showed the lowest gap (7%±2%) and the highest DC (64.3%±0.4%), and the Filtek Bulk-fill presented a marginal gap (17.8%±3.4%) and a DC (54.5%±2.7%) similar to the control materials. The VS values of both bulk-fill materials were similar to those of Tetric N-Flow and lower than that of Z350 XT Flowable Restorative.Conclusions: Bulk-fill composites showed either similar or significantly lower interfacial gaps and PS than the control flowable composites. The self-adhesive composites showed a significantly higher gap percentage and PS than the control and bulk-fill materials.

The use of different adhesive filling material and mass combinations to restore class II cavities under loading and shrinkage effects: a 3D-FEA

3D tooth models were virtually restored: flowable composite resin + bulk-fill composite (A), glass ionomer cement + bulk-fill composite (B) or adhesive + bulk-fill composite (C). Polymerization shrinkage and masticatory loads were simulated. All models exhibited the highest stress concentration at the enamel-restoration interfaces. A and C showed similar pattern with lower magnitude in A in comparison to C. B showed lower stress in dentine and C the highest cusps displacement. The use of glass ionomer cement or flowable composite resin in combination with a bulk-fill composite improved the biomechanical behavior of deep class II MO cavities.

Development of dual-cured resin cements with long working time, high conversion in absence of light and reduced polymerization stress

OBJECTIVE

This study evaluated the properties of experimental dual-cured cements containing thiourethane (TU) and low concentrations of p-Tolyldiethanolamnie (DHEPT) and benzoyl peroxide (BPO) as chemical initiators.

METHODS

BisGMA/TEGDMA-based dual-cured cement was formulated with 1.0 wt% DHEPT and 0.75 wt% BPO as initiators and used as control. The concentration of BPO was adjusted to 0.1 wt% in catalyst paste of experimental cements, and two base pastes containing TU and 0.5 wt% or 0.25 wt% of DHEPT were formulated. The rheological behavior and kinetics of polymerization of cements were assessed in the absence of light activation. The kinetics of polymerization was also evaluated for cements light-activated immediately or 5 min after the start of mixing. Polymerization stress, flexural strength and elastic modulus (n = 5) were also evaluated under these conditions.

RESULTS

Cements with TU presented lower viscosity than the control, improved working time (0.25% DHEPT > 0.5% DHEPT) and higher conversion in the absence of light-activation. Delaying the light-activation reduced the maximum rate of polymerization (Rpmax) but did not affect the conversion or stress. The addition of TU increased the Rpmax and conversion, and reduced the stress when compared to the control, without affecting the flexural strength. Except for the control with delayed light-activation (highest values), the other experimental conditions yielded similar modulus.

SIGNIFICANCE

Adding TU and using a low concentration of DHEPT/BPO resulted in dual-cured cements with longer working time, reduced polymerization stress and increased conversion even in the absence of light, with no significant effect on the mechanical properties.

Influence of Bulk-fill Restoration on Polymerization Shrinkage Stress and Marginal Gap Formation in Class V Restorations

Clinical Relevance

Restoring Class V cavities with a regular bulk-fill composite presents a more favorable biomechanical behavior than restoring with a regular nano-filled composite.

SUMMARY

Purpose:

This study evaluated the influence of Class V cavity extension and restorative material on the marginal gap formation, before and after aging, and the theoretical polymerization shrinkage stress distribution in a tooth restoration.

Methods and Materials:

Class V cavities with the depth of 2 mm, cervical/incisal distance of 4 mm, and margins located in the enamel 1 mm above the cementoenamel junction were prepared in 60 bovine incisors in two mesiodistal dimensions (n=30): 2.9-mm large extension cavities (LE) or 1.4-mm small extension cavities (SE). The cavities' depths were validated using a periodontal probe, while the mesiodistal and cervical/incisal distances were measured using a stereomicroscope. After adhesive application (Clearfil SE Bond), each group was randomly divided into two groups (n=15) according to the restorative material: Filtek Z350 XT (N) or Filtek Bulk Fill Posterior (BF). The marginal gap formation between the tooth structure and the restorative material was evaluated using a stereomicroscope before and after thermocycling for 15,000 cycles (5°C and 55°C). Data were analyzed using repeated-measures analysis of variance (ANOVA) and Tukey test for multiple comparisons (α=0.05). A three-dimensional geometric model with the same dimensions as the experimental test was created for each cavity, and the restorations were modeled for each restorative material. In the analysis software, the finite element mesh was created with tetrahedral quadratic elements, and the polymerization shrinkage was simulated by thermal analogy. The maximum principal stress was used to express the tensile stress in the adhesive interface through colorimetric graphs.

Results:

For the marginal gap, the repeated-measures ANOVA revealed a significant effect only for the factors composite resin (df=1, F=4.09, p=0.04) and thermal aging (df=1, F=44.35, p&lt;0.001). For all numerical simulations, higher stress concentration occurred at the enamel margin, and the stress peak decreased in the following sequence: LE-N (17.0 MPa) &gt; SE-N (15.0 MPa) &gt; LE-BF (9.1 MPa) &gt; SE-BF (8.2 MPa).

Conclusion:

Marginal gaps in the specimens fell between approximately 12 and 17 μm; however, the regular bulk-fill composite showed less gap formation and better stress distribution around the cavity margin than the regular nano-filled composite, regardless of the cavity extension.

Adhesive class I restorations in sound molar teeth incorporating combined resin-composite and glass ionomer materials: CAD-FE modeling and analysis

OBJECTIVES

To investigate the influence of different resin composite and glass ionomer cement material combinations in a "bi-layer" versus a "single-layer" adhesive technique for class I cavity restorations in molars using numerical finite element analysis (FEA).

MATERIALS AND METHODS

Three virtual restored lower molar models with class I cavities 4mm deep were created from a sound molar CAD model. A combination of an adhesive and flowable composite with bulk fill composite (model A), of a glass ionomer cement with bulk fill composite (model B) and of an adhesive with bulk fill composite (model C), were considered. Starting from CAD models, 3D-finite element (FE) models were created and analyzed. Solid food was modeled on the occlusal surface and slide-type contact elements were used between tooth surface and food. Polymerization shrinkage was simulated for the composite materials. Physiological masticatory loads were applied to these systems combined with shrinkage. Static linear analyses were carried out. The maximum normal stress criterion was adopted as a measure of potential damage.

RESULTS

All models exhibited high stresses principally located along the tooth tissues-restoration interfaces. All models showed a similar stress trend along enamel-restoration interface, where stresses up to 22MPa and 19MPa was recorded in the enamel and restoration, respectively. A and C models showed a similar stress trend along the dentin-restoration interface with a lower stress level in model A, where stresses up to 11.5MPa and 7.5MPa were recorded in the dentin and restoration, respectively, whereas stresses of 17MPa and 9MPa were detected for model C. In contrast to A and C models, the model B showed a reduced stress level in dentin, in the lower restoration layer and no stress on the cavity floor.

SIGNIFICANCE

FE analysis supported the positive effect of a "bi-layer" restorative technique in a 4mm deep class I cavities in lower molars versus "single-layer" bulk fill composite technique.

Influence of cavosurface angle on the stress concentration and gaps formation in class V resin composite restorations

The study aimed to evaluate the influence of cavosurface angle on stress concentration and gap formation in class V restorations. Cylindrical cavities 3 mm in diameter were prepared in forty-five bovine incisors, changing only the angle of the bur in relation to the flat surface of the tooth. The cavities maintained the same volume (17.67 mm³). The samples were divided according to the cavosurface angle, into three groups (n = 15): 90°, 120°, 135°. After adhesive application (Futurabond U, VOCO), the cavity was filled with bulk placement of a resin composite (GrandioSO, VOCO). The teeth were analyzed with stereomicroscopy. Data of marginal gap formation were statistically analyzed with a one-way analysis of variance (ANOVA) followed by Tukey tests (significance level: α = 0.05). Finite element analysis (FEA) was used to study residual stress in these geometries and to correlate those stresses with experimentally measured gap formation. The elastic modulus and polymerization shrinkage were determined for FEA. Residual shrinkage stresses were expressed in maximum principal stress (MPS). There was a significant difference in the gap formation among the groups (p = 0.001). A significantly lower marginal gap formation was found for 120° and 135° angles, with no significant difference between them. The cavosurface angle at 90° caused substantially higher stresses, in the restoration interface, with greater marginal gap. For the 120° and 135° angles, the stress concentrations were smaller and were located in the dental structure. The cavosurface angle influenced the marginal gap formation and stress concentration.

CAD-FE modeling and analysis of class II restorations incorporating resin-composite, glass ionomer and glass ceramic materials

OBJECTIVES

To investigate the influence of specific resin-composite, glass ceramic and glass ionomer cement (GIC) material combinations in a "multi-layer" technique to replace enamel and dentin in class II mesio-occlusal-distal (MOD) dental restorations using 3D-Finite Element Analysis (FEA).

METHODS

Four 3D-FE models (A-D) of teeth, adhesively restored with different filling materials, were created and analyzed in comparison with a 3D model (E) of a sound lower molar. Models A, B & C had "multilayer" constructions, consisting of three layers: adhesive, dentin replacement and enamel replacement. Model A: had a low modulus (8GPa) composite replacing dentin and a higher modulus (12GPa) composite replacing enamel. Model B: had a GI cement replacing dentin and a higher modulus (12GPa) composite replacing enamel. Model C: had a low modulus (8GPa) composite replacing dentin and a very high modulus (70GPa) inlay replacing enamel. Model D: had a lithium disilicate inlay replacing both dentin and enamel with a luting cement base-layer. Polymerization shrinkage effects were simulated and a load of 600N was applied. All the materials were assumed to behave elastically throughout the entire deformation.

RESULTS

Model A showed the highest stress distribution along all the adhesive interfaces of the shrinking resin-based materials with a critical condition and failure risk marginally and internally. Model D, by contrast, showed a more favorable performance than either of the multilayer groups (A-C). Stress and displacement plots showed an elastic response similar to that obtained for the sound tooth model. Model B and Model C performed according to their bilayer material properties. The use of a non-shrink dentin component simulating a GIC clearly affected the shrinkage stress at the basis of the Model B; while the bulk resin composite having a 12GPa Young's modulus and linear polymerization shrinkage of 1% strongly influenced the biomechanical response in the bucco-lingual direction.

SIGNIFICANCE

Direct resin-based composite materials applied in multilayer techniques to large class II cavities, with or without shrinking dentin layers, produced adverse FEA stress distributions and displacements. An indirect lithium disilicate inlay used to replace lost dentin and enamel in posterior restored teeth generated lower stress levels, within the limits of the elastic FEA model.

Durability of adhesive bonds to tooth structure involving the DEJ

The importance of the Dentin Enamel Junction (DEJ) to the durability of adhesive bonds to tooth structure is unclear. In fact, no investigation has been reported on contributions of the DEJ to the fatigue resistance of the bonded interface. In this study, the durability of adhesive bonds to tooth structure involving the DEJ was quantified and compared to that of adhesive bonds to enamel only, not including the DEJ. Two different configurations of enamel bonding were considered, including when tensile stress is focused on the outer enamel (occlusal configuration) or the inner decussated enamel (decussated configuration). The resistance to failure for all bonded interfaces was assessed under both static and cyclic loading to failure. Results showed that the durability of the bonded interfaces was primarily a function of their resistance to crack initiation and growth. The bonded interface strength involving the DEJ was significantly (p ≤ 0.05) greater than that of bonds to enamel only with occlusal configuration, under both static and cyclic loading. While the fatigue strength of bonds involving the DEJ was approximately 20% greater than that for enamel bonds with occlusal configuration (7.7MPa) it was lower than that of enamel with the decussated configuration. The DEJ deterred cracks from extending readily into the dentin but it did not prevent fatigue failure. These results suggest that the durability of bonds to enamel are most dependent on the enamel rod decussation and that the DEJ plays a minor role.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Cuspal Displacement Induced by Bulk Fill Resin Composite Polymerization: Biomechanical Evaluation Using Fiber Bragg Grating Sensors

Polymerization shrinkage is a major concern to the clinical success of direct composite resin restorations. The aim of this study was to compare the effect of polymerization shrinkage strain of two resin composites on cuspal movement based on the use of fiber Bragg grating (FBG) sensors. Twenty standardized Class II cavities prepared in upper third molars were allocated into two groups (n = 10). Restorations involved the bulk fill placement of conventional microhybrid resin composite (Esthet•X® HD, Dentsply DeTrey) (Group 1) or flowable "low-shrinkage" resin composite (SDR™, Dentsply DeTrey) (Group 2). Two FBG sensors were used per restoration for real-time measurement of cuspal linear deformation and temperature variation. Group comparisons were determined using ANCOVA (α = 0.05) considering temperature as the covariate. A statistically significant correlation between cuspal deflection, time, and material was observed (p < 0.01). Cuspal deflection reached 8.8 μm (0.23%) and 7.8 μm (0.20%) in Groups 1 and 2, respectively. When used with bulk fill technique, flowable resin composite SDR™ induced significantly less cuspal deflection than the conventional resin composite Esthet•X® HD (p = 0.015) and presented a smoother curve slope during the polymerization. FBG sensors appear to be a valid tool for accurate real-time monitoring of cuspal deformation.

Five second photoactivation? A microhardness and marginal adaptation in vitro study in composite resin restorations

INTRODUCTION

Studies defining the characteristics of light curing units and photoactivation methods are necessary to allow the correct choices to be made in daily practice. This study aimed to determine whether different photoactivation protocols for composite resins [periodic level shifting (PLS) - 5 second and soft-start] are able to maintain or enhance the mechanical properties and marginal adaptation of restorations.

METHODS

Restorations were placed in bovine teeth using the following photoactivation methods: continuous light for 20 seconds (control group); PLS technology (PLS - 5 second group); and continuous light and a light guide tip distance of 6 mm after which the tip was placed at the surface of the restoration (soft-start group). The teeth were transversely sectioned in the incisal-cervical direction. Thirty halves were randomly selected for Knoop microhardness testing (n = 10). The other 30 halves were subjected to scanning electron microscopy analysis. The images obtained were measured to identify the highest marginal gap, and statistical tests for variance analysis were conducted.

RESULTS

Microhardness tests showed no statistically significant difference between the photoactivation methods analysed (P ≥ 0.01). The tests showed a difference among depths (P < 0.01), with the deeper layers being the hardest. In analysing marginal adaptation, no significant difference was identified between the higher marginal gap values in the continuous (mean = 10.36) and PLS - 5 second (mean = 10.62) groups, and the soft-start group (mean = 5.83) presented the lowest values (P < 0.01).

CONCLUSIONS

The PLS - 5 second and soft-start protocols did not alter the hardness of the restorations. Moreover, the PLS - 5 second protocol did not alter the marginal adaptation, whereas the soft-start protocol improved marginal adaptation.

Polymerization stress--is it clinically meaningful?

OBJECTIVES

The objective of this article is to discuss the evidence for polymerization shrinkage and shrinkage stress of dental composite restoratives in terms of its potential relevance to the clinical situation

METHODS

Articles relating to the issue of polymerization contraction stress generation in dental composite materials, and the factors that influence it, were reviewed and included. Particular attention was paid to evidence derived from clinical studies. Articles were identified through PubMed and through the bibliographies of other articles.

RESULTS

There is extensive evidence for the presence of polymerization contraction stress in dental composites, as well as evidence for its deleterious effects, which include marginal leakage, gap formation, cuspal deflection, tooth cracking, reduced bond strength and lowered mechanical properties of the restorative. There is little, if any, direct evidence for the clinical effect of these contraction stresses. No study has directly established a link between these stresses and enhanced postoperative sensitivity or recurrent caries, for example. However, the concern over these stresses and the manner in which they influence the placement of current composite materials demonstrates that they are considered to be very important.

CONCLUSION

Though no direct evidence exists to prove that the generation of contraction stress in dental composite restorations causes reduced clinical longevity, the indirect evidence from numerous in vitro studies and the concern over controlling their effects proves that they are clinically relevant.