Evaluation of modern bioactive restoratives for bulk-fill placement

Surface hardness and flexural strength of dual-cured bulk-fill restorative materials after solvent storage

BACKGROUND

This study aimed to evaluate the surface hardness (VHN) and biaxial flexural strength (BFS) of dual-cured bulk-fill restorative materials after solvent storage.

METHODS

Two dual-cured bulk-fill composites (Surefil One® and Activa™ Bioactive), a light-cured bulk-fill composite (Filtek One Bulk-Fill) and a resin-modified glass ionomer (Fuji II LC) were investigated. Surefil One and Activa were used in the dual-cure mode, all materials were handled according to manufacturer's instructions. For VHN determination, 12 specimens were prepared from each material and measured after 1 h (baseline), 1 d, 7 d and 30 d of storage in either water or 75% ethanol-water. For BFS test, 120 specimens were prepared (n = 30/material) and stored in water for either 1, 7 or 30 d before testing. Repeated measures MANOVA, two-way and one-way ANOVA followed by the Tukey post hoc test (p ≤ 0.05) were used to analyze the data.

RESULTS

Filtek One had the highest VHN, while Activa had the lowest. All materials exhibited a significant increase in VHN after 1d of storage in water, except for Surefil One. After 30 d of storage, VHN increased significantly in water except for Activa, while ethanol storage caused a significant time-dependent reduction in all tested materials (p ≤ 0.05). Filtek One showed the highest BFS values (p ≤ 0.05). All the materials, except for Fuji II LC, exhibited no significant differences between 1 and 30 d BFS measurements (p > 0.05).

CONCLUSIONS

Dual-cured materials had significantly lower VHN and BFS compared to the light-cured bulk-fill material. The low results of Activa VHN and Surefil One BFS, indicate that these materials should not be recommended in posterior stress-bearing areas.

Comparative of flexural strength, hardness, and fluoride release of two bioactive restorative materials with RMGI and composite resin

Aim: This study was fulfilled to evaluate the flexural strength, micro-hardness, and release of two fluoride ions of bioactive restorative materials (Cention N and Activa Bioactive), a resin modified glass ionomer (Fuji II LC), and a resin composite (Filtek z250). Methods: Forty samples from four restorative materials (Activa Bioactive, Fuji II LC, Cention N, and Filtek Z250) were provided according to the current standards of ISO 4049/2000 guide lines. Subsequently, the samples were stored for 24 hours and 6 months in artificial saliva, and successively, flexural strength and micro-hardness of the samples were measured. For each studied groups the pH was decreased from 6.8 to 4 in storage solution. The rate of changes in fluoride ion release was measured after three different storage periods of 24 hours, 48 hours, and 6 months in distilled water, according to the previous studies’ method. Two-way ANOVA, One-way ANOVA, Tukey HSD Pair wise comparisons, and independent t-tests were used to analyze data (α= 0.05). Results: The highest flexural strength and surface micro-hardness after 24 hours and also after 6 month were observed for Cention N(p<0.001).Flexural strength of all samples stored for 6 months was significantly lower than the samples stored for 24 hours(p<0.001). The accumulative amount of the released fluoride ion in RMGI, after six-month storage period in distilled water was considerably higher (p<0.001) than 24 hours and 48 hours storage. The amount of fluoride ion release with increasing acidity of the environment (from pH 6.8 to 4) in Fuji II LC glass ionomer was higher than the bioactive materials (p<0.05). Conclusion: The flexural strength of RMGI was increased after storage against the Activa Bioactive,Cention N and Z250 composite. Storage of restorative materials in artificial saliva leads to a significant reduction in micro hardness. The behavior and amount of released fluoride ions in these restorative materials, which are stored in an acidic environment, were dependent on the type of restorative material.

Influence of Manual and Ultrasonic Scaling on Surface Roughness of Four Different Base Materials Used to Elevate Proximal Dentin-Cementum Gingival Margins: An In Vitro Study

AIM

To evaluate and compare the effects of both manual and ultrasonic scaling on surface roughness of four different base materials, used for elevating dentin/cementum gingival margins of proximal cavities.

METHODS AND MATERIALS

Eighty human upper molars with compound Class II mesial cavities, with gingival margins 1 mm below the cemento-enamel junction (CEJ), were divided into four different groups according to the type of the base material used; resin-modified glass ionomer (RMGI), glass hybrid (HV-GIC), flowable bulk-fill resin composite (Bulk Flow) and bioactive ionic resin (Activa). This was followed by completing the restorations with the same resin composite. All materials were used according to the manufacturers' instructions. All groups were further subdivided into two subgroups according to the scaling technique: manual (hand) or ultrasonic. All restorative and scaling procedures were performed after fixation of specimens with acrylic beside neighboring teeth to simulate natural contact. The mean surface roughness (Ra, μm) of all specimens was measured quantitatively and qualitatively by a three-dimensional (3D) surface analyzer system at two stages; (1) after thermal cycling for 5000 cycles without scaling and (2) after scaling. Data were statistically analyzed using analysis of variance (ANOVA), Tukey post hoc tests, and paired sample t-tests (at α=0.05).

RESULTS

For baseline readings, the Bulk Flow group had the lowest Ra values, while HV-GIC group had the highest. RMGI and Activa groups had no statistical significant difference between their Ra values (p>0.05). For post scaling readings, hand scaling had significantly lower Ra values than ultrasonic scaling in all the material groups (p<0.05), except in the Bulk Flow group, where both scaling methods were not significantly different from each other (p>0.05).

CONCLUSION

Bulk Flow had the smoothest surfaces when cured against a matrix band compared with the other tested base materials. When hand and ultrasonic scaling methods were compared, the latter technique had more detrimental effect on the surface texture of the four tested base materials.

Giomer composite compared to glass ionomer in occlusoproximal ART restorations of primary molars: 24-month RCT

BACKGROUND

Occlusoproximal restorations of primary molars usually fail, so it is necessary to investigate new materials that may overcome this challenge. Thus, this trial aimed to evaluate the longevity of occlusoproximal ART restorations in primary molars using a glass ionomer cement - GIC (Equia Forte^® - GC Corp) and a Giomer resin composite - GCR (Beautifil Bulk Restorative^® - Shofu Inc) after 24 months.

METHODS

One hundred and eighty-two (182) children aged from 4 to 8 years were selected and randomly assigned to GIC or GCR. A paediatric dentist treated them in the school setting in Cerquilho, Brazil, and the restorations were assessed after 3, 6, 12, 18 and 24 months. The primary outcome was the restoration survival, evaluated using the Kaplan-Meier and superiority Cox regression analyses. Intention to treat (ITT) was performed as a sensitivity analysis using superiority test P value and confidence interval (CI = 95%). Independent variables included gender, age, molar, jaw, cavity volume and caries experience.

RESULTS

The restoration survival after 24 months was GIC = 58.1% and GCR = 49.1% (HR = 1.24; CI = 0.97-1.59). ITT analysis showed a success of GIC = 61.1% and GCR = 52.2% (RR = 1.17; CI = 0.91-1.52). The superiority hypothesis was not proved in both analyses (P > 0.05).

CONCLUSION

GCR does not have superior longevity than GIC in occlusoproximal ART restorations of primary molars.

Fracture and viscoelastic behavior of novel self-adhesive materials for simplified restoration concepts

OBJECTIVE

The aim of the study was to offer a comparative perspective on the mechanical and viscoelastic behavior of currently developed materials for simplified restoration concepts. These materials have not yet been clearly assigned whether they are complex hybrids of already known material categories or new material classes.

METHODS

A dual-cured, bulk-fill, bioactive resin-based composite (alkasite), a resin-modified glass ionomer cements (RM-GIC) with novel polymerizable acid polymers, and a glass ionomer cement (GIC) with improved adaptation to an acidic environment were compared with regard to their macro-mechanical parameters (3-point bending test, 3-PBT), fracture mechanism, quasi-static and viscoelastic behaviour (instrumented indentation test, IIT), morphology and structural appearance of the filler system (SEM analysis). The influence of surface finishing was quantified on the outcome of the 3-PBT, while the influence of aging and frequency was monitored on the outcome of the IIT. One and multiple-way analysis of variance (ANOVA) with Tukey honestly significant difference (HSD) post-hoc tests (α = 0.05) and Weibull analysis were applied.

RESULTS

Surface finishing strongly influenced the outcome of the 3-PBT for RM-GIC and GIC but not of the alkasite. The highest material reliability (Weibull parameter m) was found with the alkasite, irrespective of the curing mode. Ground specimens showed decrease reliability, except for the alkasite in the light-cured mode. The predominant failure mode originated from sub-surface defects (52.5%), followed by corner (25%), edge (18.1%), and crack arrest (4.4%). The effect of the parameter material on the quasi-static outcome of the IIT was highest on elastic/plastic parameters (p < 0.001; e.g. elastic indentation work, η_P² = 0.875), was moderate on the Martens Hardness (η_P² = 0.420), and was low on the Vickers hardness (η_P² = 0.218). The viscoelastic parameters, in particular the loss factor (tan δ) allow a clear documentation of the ongoing acid-base setting reaction during aging of one month, which was more pronounced in the GIC than in the RM-GIC. The decrease in tan δ with aging for GIC and RM-GIC reflects the maturation process and increased brittleness, while the increase in tan δ with aging reflects the polymer plasticization in the polymer-based alkasite.

CONCLUSIONS

The mechanical and viscoelastic behavior depending on surface refinement, aging and frequency clearly allow to classify the currently developed materials for simplified restoration concepts into known material categories such as RBCs (alkasite), RM-GIC or GIC.

The Effects of Various Restorative Techniques on the Fracture Resistance of Pulpotomized Permanent Premolars

AIM

This study aimed to evaluate the effects of various restorative techniques on the fracture resistance of pulpotomized premolars with mesioocclusodistal (MOD) cavities treated with mineral trioxide aggregate (MTA) or calcium enriched mixture (CEM) cement.

MATERIALS AND METHODS

One hundred and eight sound extracted maxillary premolars were randomly assigned to nine experimental groups (n = 12). The teeth in group 1 did not receive any preparation. Class II MOD cavities were prepared in the other experimental groups. In groups 2, 4, 6, and 8, tooth-colored MTA was used for pulpotomy. In groups 3, 5, 7, and 9, CEM cement was used for pulpotomy. Groups 2 and 3 were left unrestored. Groups 4 and 5 were restored with amalgam. Groups 6 and 7 were restored with a conventional composite resin, and groups 8 and 9 were restored with bulk-fill giomers. Fracture resistance was measured, the fracture pattern of each specimen was assessed, and the results were statistically analyzed.

RESULTS

The fracture resistance of group 1 was significantly higher than those of the other groups (p < 0.05). The fracture resistance of group 2 (MTA + amalgam) was statistically lower than those of all experimental groups (p values < 0.05) except groups 3, 4, and 5 (p values > 0.05). No statistically significant differences were found between the groups restored with amalgam, conventional composite resin, and bulk-fill giomer (groups 4, 5, 6, 7, 8, and 9) (p values < 0.05). The highest rate of mode 1 fracture (restorable fracture) was observed in group 1 followed by groups 8 and 9.

CONCLUSION

No significant differences were found among the fracture resistances of the restored teeth using various restorative techniques. Bulk-fill giomers followed by conventional composite resin were better able to prevent unfavorable fractures compared to amalgam. Therefore, they seem to be more reliable for the restoration of pulpotomized teeth with MOD cavities.

ISO 4049 versus NIST 4877: Influence of stress configuration on the outcome of a three-point bending test in resin-based dental materials and interrelation between standards

OBJECTIVES

The study aimed to find a relationship between the most common standards used in testing resin-based materials (RBC) in a three-point bend test - ISO 4049 and NIST 4877 - using a size-strength relationship defined by the Weibull model. The direct comparison of calculated and measured data is used for validation.

METHODS

280 (n = 20) specimens were prepared from seven different light-cured RBCs. The flexural strength, FS, and modulus, E, were measured with a span of 12 mm (NIST) or 20 mm (ISO). A fractographic analysis determined the origin of fracture. One and multiple-way analysis of variance (ANOVA), the Tukey honestly significant difference (HSD) post-hoc tests (α = 0.05), Weibull statistics and Pearson correlation analysis were used for data analysis.

RESULTS

Calculated data approximate the measured data very well. FS measured according to ISO is 11 % lower and E is 17 % higher than the NIST data. The test method influenced the properties measured, but not the material ranking or the fracture mode. Fractures originated from volume defects (sub-surface) were the most common type of fracture.

CONCLUSIONS

Weibull analysis is successful to predict the scaling of strengths to other configurations in RBCs.

CLINICAL SIGNIFICANCE

The need to limit the sample size of RBCs up to the dimensions of their clinical use can benefit from the use of Weibull statistics. Weibull size-strength relationship and fractographic analysis can help to better assess the clinical behaviour of the RBCs, calculate the reliability of a restoration, and assess the nature of the flaws in the material.

The Potential of a Bioactive, Pre-reacted, Glass-Ionomer Filler Resin Composite to Inhibit the Demineralization of Enamel in Vitro

CLINICAL RELEVANCE

A prereacted, glass-ionomer filler fluoride-containing resin composite had lower remineralization potential than glass-ionomer cements but was able to inhibit enamel demineralization; thus, it may be an option for restoring dental surfaces for patients at high risk of caries.

SUMMARY

Evidence is lacking on the use of surface prereacted glass-ionomer filler resin composites to inhibit demineralization and that simulate real clinical conditions. The present laboratory study evaluated the potential of such composites to prevent demineralization and quantified fluoride (F) and other ions released from restorative materials after a dynamic pH-cycling regimen applied to the tooth material interface in vitro. The pH-cycling regimen was assessed by measuring surface hardness (SH) along with energy dispersive X-ray spectroscopy (EDX).

METHODS AND MATERIALS

Ninety blocks of bovine enamel were subjected to composition analysis with EDX, and were further categorized based on SH. The blocks were randomly divided into 6 treatment groups (n=15 each): F IX (Fuji IX Extra; GC Corporation); IZ (Ion Z, FGM); F II (Fuji II LC, GC Corporation); B II (Beautifil II, Shofu); F250 (Filtek Z250 XT, 3M ESPE); and NT (control, no treatment). The blocks were subjected to a dynamic pH-cycling regimen at 37°C for 7 days concurrently with daily alternations of immersion in demineralizing/remineralizing solutions. EDX was conducted and a final SH was determined at standard distances from the restorative materials (150, 300, and 400 μm).

RESULTS

The EDX findings revealed a significant increase in F concentration and a decrease in Ca2+ in the enamel blocks of group B II after the pH-cycling regimen (p<0.05). SH values for groups F IX, IZ, and F II were greater than those for groups B II, F250, and NT at all distances from the materials.

CONCLUSIONS

The results suggest that each of 3 restorative materials, F IX, IZ, and F II, partially inhibited enamel demineralization under a dynamic pH-cycling regimen.

Flexural strength and microhardness of bulk-fill restorative materials

BACKGROUND

Bulk-fill materials can facilitate the restorative procedure mainly for deep and wide posterior cavities. The purpose of this study was to evaluate flexural strength (biaxial flexural strength [BFS]) and microhardness (Knoop microhardness [KHN]) at different depths of bulk-fill materials.

METHODS

Five bulk-fill materials were tested: two light-curable composite resins, one dual-cure composite, one bioactive restorative, and a high-viscosity glass ionomer. A conventional composite was used as control. BFS and KHN were tested at different depths. Data was analyzed by two- and one-way ANOVAs, respectively and Tukey's post-hoc (α=0.05).

RESULTS

The high-viscosity glass ionomer material presented the lowest BFS at all depths. KHN for the two light-curable and the dual-cure bulk-fill resin composites was reduced following an increase in restoration depth, while the conventional composite, the bioactive material, and the high-viscosity glass ionomer were not affected.

CONCLUSION

There are differences in the properties of the tested materials at 4 mm depth, showing that the studied properties of some materials vary according to the cavity depth, although the results are material dependent.

CLINICAL SIGNIFICANCE

Mechanical properties of light-cured, bulk-fill materials may be affected by inadequate polymerization. Clinicians should consider complementary strategies to achieve adequate polymerization at high-increment depths.

Giomers in dentistry - at the boundary between dental composites and glass-ionomers

Introduction

From the variety of direct restorative dental materials, composite resins are considered as having the most esthetic and functional properties. The conservative preparation, esthetic results, good mechanical qualities and surface finishing properties of dental composites, combined with the protective properties of fluoride from glass-ionomers, led to a new generation of dental materials: the giomers.

Objective

The purpose is to review the available literature about the giomers, regarding the chemical composition, handling properties and esthetics, adhesion and microleakage, fluoride releasing and protection offered, clinical indications.

Method

The search was carried out using ScienceDirect and PubMed databases with the following keywords: giomer, esthetic properties giomers and fluoride releasing giomers. A total of 232 articles were initially selected, with the following inclusion criteria: full text articles, written in English, with topics on the properties and the clinical implications of giomers. Papers presented as abstract were not included. In the next step, review articles, duplicates, and articles in other languages were removed; as a result, a total of 44 sources published between 2004 and 2017 were selected.

Results

The selected articles referred to the following aspects about the giomers: chemical composition (8 articles), adhesion and microleakage (10 articles), fluoride releasing and pulp protection (15 articles), clinical indications (6 articles), effects of additional treatments and dietary habits (11 articles).

Oroactive dental biomaterials and their use in endodontic therapy

Dental biomaterials have revolutionized modern therapies. Untreated dental caries remains the major etiological factor for endodontic treatment, and together with a decreasing rate of tooth loss escalates the importance of continuously improving the materials used for endodontic therapies. Endodontic biomaterials are used for vital pulp therapies, irrigation, intracanal medicaments, obturation and regenerative procedures. These materials offer several functions including: antimicrobial activity, mechanical reinforcement, aesthetics, and therapeutic effects. Vital pulp therapies have seen an improvement in clinical results with an incremental approach to build on the strengths of past materials such as calcium hydroxide and calcium silicates. While sodium hypochlorite remains the gold standard for canal irrigation, numerous nanoparticle formulations have been developed to promote sustained antimicrobial action. Gutta-percha based bulk fillers remain the most common materials for root filling. However, while multiple studies focus on the development of novel formulations containing drugs, glass derivatives or ionic-, polymeric-, or drug- loaded nanoparticles, a lack of reliable and long-term clinical evidence obligates further study as experienced clinicians prefer to use what has worked for decades. This review delves in to the biochemistry of the materials to scrutinize their shortcomings, and where opportunity lies to further enhance their efficacy in endodontic practice. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 108B:201-212, 2020.

Polymerization characteristics of colored compomers cured with different LED units

Aim:

Incomplete polymerization of a resin material used for dental restoration affects the properties of the restoration. We evaluated the structural and mechanical properties of three different colored compomers cured with three different LED units to observe the characteristic changes occurring in different matches.

Methods:

Polytetrafluoroethylene molds (5 mm in diameter and 2 mm in thickness) were used to prepare disk-shaped sample specimens. Nine sample groups (each of five specimens) were prepared, three each of different compomer resin colors (gold, berry, and silver). Samples were cured using three different LED units (Optima, VALO, and Demi Ultra), according to the manufacturers’ instructions. Microstructural properties of samples were characterized by determining the degree of curing using Fourier-transform infrared spectroscopy and by analyzing sample morphology under a scanning electron microscope. The Vickers hardness, compressive strength, and elastic modulus of the samples were measured to investigate their mechanical properties.

Results:

The degrees of curing decreased in the order of silver > berry > gold for all curing units. Conversely, gold compomers exhibited poorer mechanical values than the berry and silver counterparts. The Optima 10 unit yielded slightly higher degrees of curing than the other devices, followed by Demi Ultra and VALO light-curing units, respectively.

Conclusion:

The resin color affected the structural and mechanical properties of the compomers, possibly as a result of the complex interactions and relationships between the irradiation light and resin material, such as light absorbance and reflectance; thus, depending on the color as well as the curing protocol.

Characterization of fluoride releasing restorative dental materials

This study aimed to evaluate and compare certain mechanical properties, Vickers-hardness, water sorption, fluoride-release, shrinkage-stress and wear of five commercial fluoride-releasing restorative materials (Dyract, CompGlass, BEAUTIFIL II, ACTIVA-Restorative, and GC Fuji II LC), in relation to their microstructural characteristics. Mechanical properties were determined for each material following ISO standards. A wear test was conducted with 15,000 chewing cycles using a dual-axis chewing simulator. Daily fluoride-release was measured during the first 10 days by using a fluoride ion selective electrode. Scanning electron microscopy (SEM) was used to evaluate the microstructure of each material. Results were statistically analysed using ANOVA followed by post hoc Tukey's test. ACTIVA-Restorative exhibited the highest fracture toughness (1.1 MPa m^1/2) among the materials tested. BEAUTIFIL II presented the highest flexural strength (145 MPa) which was not significantly different (p>0.05) from CompGlass and Dyract. Highest fluoride-release measurement was located for GC Fuji II LC among other tested materials.

A Deep Morphological Characterization and Comparison of Different Dental Restorative Materials

Giomer is a relatively new class of restorative material with aesthetics, handling and physical properties of composite resins, and benefits of glass ionomers: high radiopacity, antiplaque effect, fluoride release, and recharge. To verify the superior properties of Giomers, in this study, a deep morphological characterization has been performed with an in vitro comparative study among a Giomer (Beautifil® II by Shofu Dental Corporation, Osaka, Japan), a Compomer (Dyract Extra by Dentsply, Caulk, Germany), glass ionomer cement (Ketac fil plus by 3M ESPE), and a composite resin (Tetric Evoceram by Ivoclar). In particular, mechanical and optical properties and ageing effects have been compared to investigate materials similarities and differences. Indentation tests, UV-Visible spectroscopy, Raman spectroscopy, and weight loss after storage in saliva or sugary drink have been carried out to analyze materials behavior in real conditions. The results confirm the high quality of Giomer material and indicate possible improvements in their usage.