Effect of curing-light attenuation on color stability and physical and chemical properties of resin cements containing different photoinitiators

The impact of inorganic fillers, organic content, and polymerization mode on the degree of conversion of monomers in resin-matrix cements for restorative dentistry: a scoping review

PURPOSE

The main aim of the present study was to carry out a scoping review on the differences in degree of conversion of monomers regarding several types resin cements, indirect restorative materials, and light-curing procedures used in dentistry.

METHOD

A bibliographic review was performed on PubMed using the following search items: "degree of conversion" OR "filler" AND "resin cement" OR "inorganic cement" AND "organic" OR "radiopacity" OR "refractive" OR "transmittance" OR "type" AND "resin composite." The search involved articles published in English language within the last thirteen years. A research question has been formulated following the PICO approach as follow: "How different is the degree of conversion of monomers comparing several types of resin-matrix cements?".

RESULTS

Within the 15 selected studies, 8 studies reported a high degree of conversion (DC) of the organic matrix ranging from 70 up to 90% while 7 studies showed lower DC values. Dual-cured resin-matrix cements revealed the highest mean values of DC, flexural strength, and hardness when compared with light- and self-polymerized ones. DC mean values of resin-matrix cements light-cured through a ceramic veneer with 0.4 mm thickness were higher (~ 83%) than those recorded for resin-matrix cements light-cured through a thicker ceramic layer of 1.5 mm (~ 77%).

CONCLUSIONS

The highest percentage of degree of conversion of monomers was reported for dual-cured resin-matrix cements and therefore both chemical and light-induced pathways promoted an enhanced polymerization of the material. Similar degree of conversion of the same resin-matrix cement were recorded when the prosthetic structure showed a low thickness. On thick prosthetic structures, translucent materials are required to allow the light transmission achieving the resin-matrix cement.

CLINICAL RELEVANCE

The chemical composition of resin-matrix cements and the light-curing mode can affect the polymerization of the organic matrix. Thus, physical properties of the materials can vary leading to early clinical failures at restorative interfaces. Thus, the analysis of the polymerization pathways of resin-matrix cements is significantly beneficial for the clinical performance of the restorative interfaces.

Clinical Survival Rate and Laboratory Failure of Dental Veneers: A Narrative Literature Review

There is a vast amount of published literature concerning dental veneers; however, the effects of tooth preparation, aging, veneer type, and resin cement type on the failure of dental veneers in laboratory versus clinical scenarios are not clear. The purpose of the present narrative review was to determine the principal factors associated with failures of dental veneers in laboratory tests and to understand how these factors translate into clinical successes/failures. Articles were identified and screened by the lead author in January 2024 using the keywords ''dental veneer", "complication", "survival rate", "failure", and "success rate" using PubMed/Medline, Scopus, Google Scholar, and Science Direct. The inclusion criteria included articles published between January 1999 and January 2024 on the topics of preparation of a tooth, aging processes of the resin cement and veneer, translucency, thickness, fabrication technique of the veneer; shade, and thickness of the resin cement. The exclusion criteria included articles that discussed marginal and internal fit, microhardness, water sorption, solubility, polishability, occlusal veneers, retention, surface treatments, and wear. The results of the present review indicated that dental veneers generally have a high survival rate (>90% for more than 10 years). The amount of preserved enamel layer plays a paramount role in the survival and success rates of veneers, and glass-ceramic veneers with minimal/no preparation showed the highest survival rates. Fracture was the primary failure mechanism associated with decreased survival rate, followed by debonding and color change. Fractures increased in the presence of parafunctional activities. Fewer endodontic complications were associated with veneer restorations. No difference was observed between the maxillary and mandibular teeth. Clinical significance: Fractures can be reduced by evaluation of occlusion immediately after cementation and through the use of high-strength veneer materials, resin cements with low moduli, and thin layers of highly polished veneers. Debonding failures can be reduced with minimal/no preparation, and immediate dentin sealing should be considered when dentin is exposed. Debonding can also be reduced by preventing contamination from blood, saliva, handpiece oil, or fluoride-containing polishing paste; through proper surface treatment (20 s of hydrofluoric acid etching for glass ceramic followed by silane for 60 s); and through use of light-cured polymerization for thin veneers. Long-term color stability may be maintained using resin cements with UDMA-based resin, glass ceramic materials, and light-cure polymerization with thin veneers.

Evaluation of the Selected Mechanical and Aesthetic Properties of Experimental Resin Dental Composites Containing 1-phenyl-1,2 Propanedione or Phenylbis(2,4,6-trimethylbenzoyl)-phosphine Oxide as a Photoinitiator

The goal of this study was to compare the mechanical properties of experimental resin dental composites containing a conventional photoinitiating system (camphorquinone CQ and 2-(dimethylami-no)ethyl methacrylate (DMAEMA)) to a photoinitiator system containing 1-phenyl-1,2 propanedione (PPD) with 2-(dimethylami-no)ethyl methacrylate) or acting alone phenylbis(2,4,6-trimethylbenzoyl)-phosphine oxide (BAPO). The manually produced composites consisted of an organic matrix: bis-GMA (60 wt. %), TEGDMA (40 wt. %), and silanized silica filler (45 wt. %). The composites contained 0.4/0.8 wt. %, 0.8/1.6 wt. %, and 1/2 wt. % of PPD/DMAEMA and another group included 0.25, 0.5, or 1 wt. % of BAPO. Vickers hardness, microhardness (in the nanoindentation test), diametral tensile strength, and flexural strength were assessed, and CIE L* a* b* colorimetric analysis was conducted for each composite produced. The highest average Vickers hardness values were obtained for the composite containing 1 wt. % BAPO (43.73 ± 3.52 HV). There was no statistical difference in the results of diametral tensile strength for the experimental composites tested. The results of 3-point bending tests were the highest for composites containing CQ (77.3 ± 8.84 MPa). Despite the higher hardness of experimental composites including PPD or BAPO, compared with composites with CQ, the overall results indicate that the composite with CQ still represents a better solution when used as a photoinitiator system. Moreover, the composites containing PPD and DMAEMA are not promising in terms of color or mechanical properties, especially as they require significantly longer irradiation times.

Lignin-derived new hydrogen donors for photoinitiating systems in dental materials

OBJECTIVES

The aim of this study is to develop amine free photo-initiating system (PIs) for the photopolymerization of dental methacrylate resins, using seven new hydrogen donors HDA-HDG derived from β-O-4 lignin model.

METHODS

Seven experimental CQ/HD PIs were formulated with Bis-GMA/TEGDMA (70 w%/30 w%). CQ/EDB system was chosen as the comparison group. FTIR-ATR was used to monitor the polymerization kinetics and double bond conversion. Bleaching property and color stability were evaluated using a spectrophotometer. Molecular orbitals calculations were used to demonstrate C-H bond dissociation energies of the novel HDs. Depth of cure of the HD based systems were compared to the EDB based one. Cytotoxicity was also studied by CCK8 assay using tissue of mouse fibroblasts (L929 cells).

RESULTS

Compared to CQ/EDB system, the new CQ/HD systems show comparable or better photopolymerization performances (1 mm-thick samples). Comparable or even better bleaching properties were also obtained with the new amine-free systems. Comparing to EDB, all HDs exhibited significantly lower C-H bond dissociation energies by molecular orbitals calculations. Groups with new HD showed higher depth of cure. OD and RGR values were similar to that of the CQ/EDB group, ensuring the feasibility of the new HDs in dental materials.

CLINICAL SIGNIFICANCE

The new CQ/HD PI systems could be potentially useful in dental materials, presenting improvements in restorations' esthetic and biocompatibility.

Effect of thickness of CAD/CAM materials on light transmission and resin cement polymerization using a blue light-emitting diode light-curing unit

OBJECTIVE

Evaluate the effect of thickness of high-translucency (HT) CAD/CAM materials on irradiance and beam profile from a blue light-emitting diode light-curing unit (LCU) and on the degree of conversion (DC) and maximum polymerization rate (Rp_max ) of a light-cured resin cement (LCC).

MATERIAL AND METHODS

The direct output from the LCU, the light transmission and irradiance ratio (IR) through one conventional composite and nine HT CAD/CAM materials (0.5, 1.0, 1.5, or 2.0-mm thick; n = 5) were measured with a integrating sphere coupled to a spectrometer. The light beam was assessed with a beam profiler camera. The DC at 600 s and the Rp_max of one LCC was determined using a Fourier transform infrared spectrometer (n = 5). Data were analyzed by ANOVA followed by Tukey's tests, and Dunnett's test was also used for irradiance data (α = 0.05).

RESULTS

A significant decrease in irradiance through all materials occurred as thickness increased. Thin CAD/CAM materials improved light homogeneity, which decreased with the increase in thickness. The DC of the LCC directly exposed to light was the same as when exposed to 45%, 25%, 15%, or 5% IRs. Rp_max decreased with the decrease in IR.

CONCLUSIONS

Although the HT CAD/CAM materials reduced the irradiance from the LCU, minor effects were observed in the LCC's DC.

CLINICAL SIGNIFICANCE

Despite the light attenuation of blue light through different CAD/CAM materials that were up to 2-mm thick, the degree of conversion of one brand of light-cured resin cement was clinically acceptable when the LCU was used for 30 s.

Dental Luting Cements: An Updated Comprehensive Review

The cementation of indirect restoration is one of the most important steps in prosthetic and restorative dentistry. Cementation aims to bond the prosthetic restoration to the prepared enamel or enamel and dentine. Successful cementation protocols prevent biofilm formation at the margin between tooth and restoration and minimize mechanical and biological complications. With the advancements in dental cements, they have been modified to be versatile in terms of handling, curing, and bond strengths. This review presents updates on dental cements, focusing on the composition, properties, advantages, limitations, and indications of the various cements available. Currently, dental restorations are made from various biomaterials, and depending on each clinical case, an appropriate luting material will be selected. There is no luting material that can be universally used. Therefore, it is important to distinguish the physical, mechanical, and biological properties of luting materials in order to identify the best options for each case. Nowadays, the most commonly used dental cements are glass-ionomer and resin cement. The type, shade, thickness of resin cement and the shade of the ceramic, all together, have a tangible influence on the final restoration color. Surface treatments of the restoration increase the microtensile bond strength. Hence, the proper surface treatment protocol of both the substrate and restoration surfaces is needed before cementation. Additionally, the manufacturer's instructions for the thin cement-layer thickness are important for the long-term success of the restoration.

Effect of light attenuation through veneers on bond strength of adhesives with photoinitiator combinations

This study aimed to evaluate the effect of light attenuation through ceramic veneers and resin cement on degree of conversion (DC), cohesive strength (CS), and microshear bond strength (μSBS) of experimental adhesive systems. Experimental etch-and-rinse and self-etch adhesives were combined with different ratios of camphorquinone (CQ) and diphenyl(2,4,6-trimethylbenzoyl) phosphine oxide (TPO) photoinitiators: CQ-only; 3CQ:1TPO; 1CQ:1TPO; 1CQ:3TPO and TPO-only. Square-shaped ceramic veneer (IPS Empress Esthetic, Ivoclar Vivadent) (n = 10; 10mm long x 10mm wide x 0.5mm thick) and resin cement specimens (Variolink Esthetic LC, Ivoclar Vivadent) (n = 10; 10 mm long x 10 mm wide and 0.3 mm thick) were prepared. Light transmittance of a multiple-peak LED (Bluephase G2, Ivoclar Vivadent) was measured through restorative materials using a spectrometer (n = 5). Adhesive specimens were analyzed for DC, CS, and μSBS by light-curing the adhesive with or without (control) ceramic veneer, and with resin cement fixed to output region of the light-curing tip (n = 10). Data were submitted to ANOVA and Tukey's test (α = 0.05). Total light transmittance through the restorative materials was attenuated, and this attenuation was more evident for the violet spectrum. The DC for the TPO groups in ratios up to 1CQ:1TPO was similar to the control. 1CQ:3TPO showed lower values for CS. μSBS was reduced for all groups with light attenuation, but lower values were observed for 1CQ:3TPO and TPO-only. In conclusion, light transmission was reduced with interposed restorative materials. Adhesives combined with CQ and TPO up to 1CQ:1TPO showed greater cure efficiency and mechanical properties compared with a higher amount of TPO.

Influence of the activation mode on long-term bond strength and endogenous enzymatic activity of dual-cure resin cements

Objective

To investigate the long-term microtensile bond strength (µTBS), interfacial nanoleakage expression (NL), and adhesive stability of dual-cure resin cements with/out light activation to dentin.

Materials and methods

Composite overlays (N = 20) were luted to deep dentin surfaces with RelyX Ultimate (RXU, 3M) or Variolink EstheticDC (VAR, Ivoclar-Vivadent). A universal adhesive was used for bonding procedures (iBond universal, Heraeus Kulzer). The resin cements were either self-cured (SC; 1 h at 37 °C) or dual-cured (DC; 20s light-cure followed by 15 min self-cure at 37 °C). Specimens were submitted to µTBS immediately (T₀) or after 1 year of laboratory storage (T₁₂). The fracture pattern was evaluated using scanning electron microscopy (SEM). Data were statistically analyzed with two-way ANOVA/Tukey test. Further, the NL was quantified and analyzed (chi-square test) and in situ zymography was performed to evaluate the endogenous enzymatic activity within the hybrid layer (HL) at T₀ and T₁₂ (Mann–Whitney test)_. The significance level for all statistical tests was set at p = 0.05.

Results

DC resulted in higher bond strength and decreased fluorescence at the adhesive interface, irrespective of the material and the storage period (p < 0.05). Significantly lower bonding performances (p < 0.05) and higher endogenous enzymatic activity (p < 0.05) were observed within the HL at T₁₂ compared to T₀ in all tested groups.

Conclusions

Light-curing the dual-cure resin cements, more than the cement materials, accounted for good bonding performances and higher HL stability over time when used with a universal adhesive.

Clinical significance

The curing condition influences the bonding performances of dual-cure resin cements to dentin when used with a universal adhesive.

Mechanical Properties of Experimental Composites with Different Photoinitiator

Objective  The effect of different photoinitiators on mechanical properties of experimental composites was evaluated.

Materials and Methods  Resin composites were formulated by using a blend of bisphenol A-glycidyl and triethylene glycol (50/50 wt%) dimethacrylate monomers, and 65 wt% of barium aluminium silicate and silica filler particles. Photoinitiators used were 0.2% camphorquinone (CQ) and 0.8% co-initiator (DMAEMA); 0.2% phenyl-propanedione and 0.8% DMAEMA; 0.1% CQ + 0.1% phenyl propanedione and 0.8% DMAEMA; 0.42% mono(acyl)phosphine oxide (MAPO); and 0.5% bis(acyl)phosphine oxide (BAPO). Specimens ( n = 10) were light cured by using a multiple-emission peak light-emitting diode for 20 seconds at 1,200 mW/cm ² of irradiance and Knoop hardness and plasticization, depth of cure, flexural strength, and elastic modulus were evaluated. Data were statiscally analyzed at significance level of α = 5%.

Results  Experimental composites containing MAPO and BAPO photoinitiators showed the highest values of flexural strength, elastic modulus, top surface hardness, and lower hardness reduction caused by alcohol compared with CQ. Composites containing CQ and PPD showed similar results, except for depth of cure and hardness of bottom surface.

Conclusion  BAPO and MAPO showed higher flexural strength, elastic modulus, hardness on top surface, and lower polymer plasticization to CQ.

Effect of an elastomeric urethane monomer on BisGMA-free resin composites containing different co-initiators

OBJECTIVES

The aim of this study was to investigate the mechanical, chemical, optical, and adhesive properties of BisGMA-free experimental resin composites containing Exothane-24-an elastomeric urethane monomer-and different co-initiators.

MATERIALS AND METHODS

A blend of urethane dimethacrylate (UDMA), extended dimethacrylate urethane (PEG 400), triethylene glycol dimethacrylate (TEGDMA), and camphorquinone was prepared. Two different co-initiators-dimethyl aminoethyl methacrylate (DMAEMA) or 4-N alcohol, N-dimethylamine phenylethyl (DMPOH)-were added to the blend. Exothane-24 monomer was added to the blend for each co-initiator and four groups were established as follows: DMAEMA; DMAEMA + Exothane; DMPOH; and DMPOH + Exothane. Specimens were photo-activated using a multi-wave LED light-curing unit (VALO; 954 mW/cm² of irradiance). Mechanical (ultimate tensile strength, flexural strength, flexural modulus and hardness), chemical (degree of conversion, hardness reduction, water sorption and solubility), optical (color change), and adhesive (microtensile bond strength) properties were analyzed. Data were submitted to two-way ANOVA and Tukey's test (α = 0.05).

RESULTS

The resin composite containing DMPOH and Exothane-24 showed similar or superior performance to those of the other experimental composites for mechanical and chemical properties, except for flexural strength. It also showed less color change and greater micro-tensile bond strength.

CONCLUSIONS

Among the combinations tested, the BisGMA-free resin composite containing Exothane-24 combined with the DMPOH co-initiator showed the best mechanical, chemical, optical, and adhesive properties. Clinical relevance Exothane-24 monomer and DMPOH co-initiator could be useful in the formulation of BisGMA-free resin composites in order to minimize exposure to BPA.

The Photoinitiators Used in Resin Based Dental Composite-A Review and Future Perspectives

The presented paper concerns current knowledge of commercial and alternative photoinitiator systems used in dentistry. It discusses alternative and commercial photoinitiators and focuses on mechanisms of polymerization process, in vitro measurement methods and factors influencing the degree of conversion and hardness of dental resins. PubMed, Academia.edu, Google Scholar, Elsevier, ResearchGate and Mendeley, analysis from 1985 to 2020 were searched electronically with appropriate keywords. Over 60 articles were chosen based on relevance to this review. Dental light-cured composites are the most common filling used in dentistry, but every photoinitiator system requires proper light-curing system with suitable spectrum of light. Alternation of photoinitiator might cause changing the values of biomechanical properties such as: degree of conversion, hardness, biocompatibility. This review contains comparison of biomechanical properties of dental composites including different photosensitizers among other: camphorquinone, phenanthrenequinone, benzophenone and 1-phenyl-1,2 propanedione, trimethylbenzoyl-diphenylphosphine oxide, benzoyl peroxide. The major aim of this article was to point out alternative photoinitiators which would compensate the disadvantages of camphorquinone such as: yellow staining or poor biocompatibility and also would have mechanical properties as satisfactory as camphorquinone. Research showed there is not an adequate photoinitiator which can be as sufficient as camphorquinone (CQ), but alternative photosensitizers like: benzoyl germanium or novel acylphosphine oxide photoinitiators used synergistically with CQ are able to improve aesthetic properties and degree of conversion of dental resin.