Marginal integrity of provisional resin restoration materials: A review of the literature

Achieving Predictable Esthetics With Early Implant Placement and Soft Tissue Modeling: A Case Report and Literature Review

In the modern era, patients are increasingly concerned about dental esthetics. Edentulism can significantly impact the appearance, occlusion, and self-esteem of the patient. Treatment options like removable dentures, fixed crown and bridge prostheses, and resin-retained bridges are available to replace missing teeth. Implant therapy is popular due to its high success rates and long-term durability. However, its efficacy can be compromised by errors in treatment planning, surgery, tissue care, and infections. Thus, meticulous planning and execution are crucial. Clinicians must have the expertise to manage difficulties during surgery and maintain stable soft tissue. The stability of tissues around osseointegrated implants affects long-term clinical stability and esthetics. Early implant placement is recommended for missing teeth in the esthetic zone, aiming to place implants in anatomically and functionally correct positions for durable and esthetic results. Patients with high cosmetic demands, thin gingival biotypes, and high smile lines pose challenges. Assessing Pink and White esthetics guides treatment planning. Advantages of early implant placement include simplified procedures and reduced post-surgical complications. Soft tissue molding is achieved using customized healing abutments and temporizing with fiber-reinforced resin-bonded prostheses. Customized healing abutments preserve socket width, prevent soft tissue collapse, and promote natural contouring, eliminating the need for secondary surgeries and aiding spontaneous healing. This case report outlines a comprehensive approach to achieving predictable esthetics through early implant placement and soft tissue modeling in a patient with a traumatically avulsed maxillary central incisor.

A Comparative Clinical Performance of Polymethyl Methacrylate (PMMA) and Urethane Dimethacrylate (UDMA) Materials in Provisional Fixed Prostheses

AIM

This study aimed to compare the clinical outcomes of polymethyl methacrylate (PMMA) and urethane dimethacrylate (UDMA) as materials for fixed provisional restorations, focusing on handling properties, chair time, and periodontal outcomes, due to their prevalent use in dental practice.

MATERIALS AND METHODS

A comparative clinical study was conducted with 150 patients at the Department of Fixed Prosthodontics, Damascus University, Damascus, Syria. Patients undergoing prosthetic treatments with crowns and bridges received two fixed provisional restorations using a direct approach. The first, made immediately after abutment preparation, used PMMA. The second, created post-clinical try-in of the final restoration, utilized UDMA. Both restorations were maintained for one week. We assessed chair time, handling properties via the Visual Analog Scale (VAS), and periodontal health using the Plaque Index and Gingival Index. The Kolmogorov-Smirnov test was used to assess data normality. Differences between the two groups in the outcome variables were analyzed using the Mann-Whitney U test. The level of significance was set at (P < 0.05).

RESULTS

The handling properties of chemically activated PMMA resin were superior to those of light-activated UDMA resin. However, UDMA resin outperformed in terms of chair time and periodontal outcomes. The mean chair time was 9.45 ± 1.01 minutes for PMMA and 4.40 ± 0.77 minutes for UDMA. Mild gingivitis or plaque accumulation was observed in 57.3% of PMMA restorations and 44.0% of UDMA restorations. Moderate gingivitis and plaque accumulation were noted in 42.7% of PMMA restorations, while 56.0% of UDMA restorations showed no plaque accumulation or gingival inflammation.

CONCLUSION

Chemically activated PMMA resin offers excellent handling properties, whereas light-activated UDMA resin provides advantages in chair time and periodontal health, making it a preferable choice for provisional restorations. Limitations and future research: The study was limited to short-term outcomes and did not assess the long-term durability of the restorations or their aesthetic impact on patient satisfaction. Further studies are recommended to evaluate the long-term performance of these materials, their cost-effectiveness, and their aesthetic outcomes to provide a more comprehensive understanding of their clinical utility.

Shear bond strength of orthodontic brackets to specimens fabricated from temporary restorative materials by 3D-printing, CAD/CAM technology, and the conventional technique after surface treatment by sandblasting and laser

OBJECTIVES

This study assessed the shear bond strength (SBS) of stainless steel (SS) orthodontic brackets to specimens fabricated from polymethyl methacrylate (PMMA) temporary restorative material by 3D-printing, computer-aided design/computer-aided manufacturing (CAD/CAM) technology, and the conventional technique, after surface treatment by sandblasting and laser.

MATERIAL AND METHODS

In this in vitro study, 60 disc-shaped specimens with 8mm diameter and 1mm height were fabricated from PMMA temporary restorative material by 3D-printing, CAD/CAM, and the conventional technique. In each group (n=20), half of the specimens were sandblasted while the other half underwent Er,Cr:YSGG laser irradiation. Brackets were bonded to the specimens and underwent thermocycling followed by SBS testing. Data were analysed by one-way ANOVA, independent t-test, and LSD test (alpha=0.05).

RESULTS

A significant difference existed among the three fabrication methods in SBS in both laser (P<0.001) and sandblasting (P<0.001) surface treatment groups. In laser group, the mean SBS of CAD/CAM (P=0.000) and conventional (P=0.000) groups was significantly lower than that of 3D-printing group. In sandblasting group, the SBS of CAD/CAM group was significantly lower than 3D-printing (P=0.000) and conventional (P=0.000) groups. The mean SBS of laser-treated specimens was significantly higher than sandblasted specimens in 3D-printing group (P=0.000), and significantly lower than sandblasted specimens in the conventional group (P=0.000). A significantly higher SBS was obtained by laser treatment compared with sandblasting irrespective of the fabrication method (P=0.000).

CONCLUSION

The highest SBS of SS orthodontic brackets to temporary restorative material was recorded for 3D-printed specimens treated by Er,Cr:YSGG laser irradiation.

Fracture strength of Er,Yag laser treated PMMA denture-based polymer (DBP) colonized with C. albicans, S. aureus, S.mutans, and E.coli

AIM

To assess and equate the efficacy of different disinfection protocols autoclave, chlorhexidine (CHX), PDT utilizing Rose Bengal (RB), chitosan, and Er, Yag laser and their effect on fracture strength of PMMA denture-based polymer (DBP) colonized with C. Albicans, S. aureus, S.mutans, and E.coli.

MATERIAL AND METHODS

A total of 50 (n = 10) PMMA DBP were manufactured and adulterated with the American Type Culture Collection (ATCC) of diverse microbial colonies inhabited by C. Albicans, S. aureus, S.mutans, and E.coli. The specimens were subjected to different denture disinfection approaches by randomly distributing in into five groups i.e., Er, Yag laser, RB, autoclave, CHX, and Chitosan, respectively for appraising antimicrobial effectiveness. PMMA fracture load was also assessed and statistical analysis was performed for CFU/mL (log10) of exposed C. Albicans, S. aureus, S.mutans, and E.coli by one-way ANOVA and Tukey's multiple comparison test at a significance level of p < 0.05.

RESULTS

Intergroup comparison disclosed that denture disinfection with Er, Yag laser, autoclave, Chitosan, and CHX (control) validated comparable antimicrobial efficacy to denture against all inspected CFU/mL (log10) (p>0.05). The intragroup comparison revealed that DBP sanitization with Er, Yag laser, autoclave, Chitosan, RB, and CHX substantiated equivalent effective antimicrobial efficacy in plummeting CFU/mL (log10) of S. mutans and E. coli (p>0.05) but in consideration to S.aureus and C.albicans, all groups resulted in declining their count except 5µm RB activated by PDT(p < 0.05). No significant difference was perceived in fracture load of PMMA denture base among Er, Yag laser, RB, chitosan, and CHX (control) (p > 0.05) except autoclave decontamination procedure that indicated the least fracture strength of DBP when disinfected (p < 0.05).

CONCLUSION

Er, Yag laser, and Chitosan activated by PDT have the potential to be used as an alternative to chlorhexidine for disinfecting Polymethyl methacrylate denture base as they demonstrated the highest antimicrobial efficacy against E. coli, C. Albicans, S aureus, and S. mutans with optimal fracture load.

Investigation of the marginal fit of a 3D-printed three-unit resin prosthesis with different build orientations and layer thicknesses

PURPOSE

The purpose of this study was to analyze the marginal fit of three-unit resin prostheses printed with the stereolithography (SLA) method in two build orientations (45°, 60°) and two layer thicknesses (50 µm, 100 µm).

MATERIALS AND METHODS

A master model for a three-unit resin prosthesis was designed with two implant abutments. Forty specimens were printed using an SLA 3D printer. The specimens were printed with two build orientations (45°, 60°), and each orientation was printed with two layer thicknesses (50 µm, 100 µm). The marginal fit was measured as the marginal gap (MG) and absolute marginal discrepancy (AMD), and MG and AMD measurements were performed at 8 points per abutment, for 16 points per specimen. All statistical analyses were performed using SPSS software. Two-way analysis of variance (ANOVA) was separately performed on the MG and AMD values of the build orientations and layer thicknesses. Moreover, one-way ANOVA was performed for each point within each group.

RESULTS

The margins of the area adjacent to the pontic showed significantly high values, and the values were smaller when the build orientation was 45° than when it was 60°. However, the margin did not differ significantly according to the layer thicknesses.

CONCLUSION

The marginal fit of the three-unit resin prosthesis fabricated by the SLA 3D method was affected by the pontic. Moreover, the marginal fit was affected by the build orientation. The 45° build orientation is recommended.

Interleukin-1β activity in gingival crevicular fluid of abutment teeth with temporary fixed restorations versus final fixed restorations: Prospective observational study

Objective

To compare the effect of temporary fixed restorations to final fixed restorations on gingival health of abutment tooth by evaluating the level of IL-1β in gingival crevicular fluid (GCF) as an inflammatory biomarker.

Subjects and methods

It was a nonrandomized prospective observational study. Samples of GCF were collected from 24 participants with provisional and permanent definitive full-coverage restorations with subgingival margin placements at three intervals for each participant: Interval 1, after preparation and immediately before cementation of temporary fixed restoration. Interval 2, after two weeks of temporization and before receiving the final fixed restoration. Interval 3, after two weeks of final fixed restorations. GCF were collected from gingival crevice of the abutment tooth by pre-prepared filter paper with dimensions of 2mmx13mm. They were prepared for IL-1β concentration assay by enzyme-linked immuno sorbent assay – analysis (ELIZA).

Results

Were analyzed by SAS® software, Descriptive means and medians were used and the repeated ANVOA test was applied (1st interval) showed the highest level of IL-β (13.587 ± 5.735). In 2nd interval the level of IL-β was significantly reduced (9.602 ± 3.279). While, in 3rd interval the level of IL-β was the lowest (6.293 ± 3.279).

Conclusion

The material and technique of fabrication of both temporary and final fixed restorations are critical for gingival health. PMMA CAD-CAM based temporary restorations showed to be compatible to gingival health by decreasing the level of IL-β level, but the zirconia as a final fixed restoration showed to have optimum compatible effect on gingival health.

Surface degradation effects of carbonated soft drink on a resin based dental compound

Dental compounds and restorative materials undergo surface degradation and erosion from exposure to a variety of dietary substances. In this study we investigated changes in the surface properties of Rebaron, a hard denture reline material (HDRM), following timed immersion in carbonated soft drinks to determine its durability in a common acidic environment. Samples were prepared and immersed in a carbonated soft drink (or its components) for 6, 12, or 24 h. Surface structure and mechanical properties were characterized using Atomic Force Microscopy (AFM). Raman spectroscopy was used to identify changes in the HDRM surface chemistry following exposure to the test solutions. AFM revealed that prolonged exposure led to pit formation and a subsequent increase in surface roughness, from 302.02 ± 30.20 to 430.59 ± 15.07 nm Ra, following a 24 h exposure. Young's modulus values decreased from 9.3 ± 7.0 to 0.53 ± 0.26 GPa under the same conditions, demonstrating a softening and embrittlement of the HDRM sample. Raman results revealed that immersion in the carbonated soft drink or acidic solution changed the nature of the HDRM structure, converting the HDRM surface chemistry from primarily hydrophobic to hydrophilic. Our study indicates that sustainability and durability of Rebaron HDRM are significantly reduced by prolonged exposure to carbonated (acidic) soft drink, resulting in deformation and degradation of the material surface.

Effect of various digital cement space settings on the adaptation of CAD/CAM occlusal veneer "micro-ct evaluation"

The aim was to evaluate the adaptation of CAD/CAM occlusal veneer with different cement space settings using micro CT scan. Three groups of IPS e.max-CAD lithium disilicate occlusal veneers with different cement space settings (30, 40, and 50 µm) were produced. A circle with 20 different diameters was centered at the center of the same image position of every scanned specimen using micro CT scan to measure four different locations [Occlusal (OCG), axial (AXG), Marginal (MAG), and absolute marginal discrepancy values (AMD)]. Kruskal-Wallis test revealed that there were no statistical differences between (OCG), (AXG), and (AMD) tested groups (p>0.05), and statistical differences between (MAG) group and other two groups (p<0.05). An increase in the digital cement space significantly improved the marginal fit of IPS e.max-CAD occlusal veneer.

Marginal integrity of aesthetic restorations following intracoronal bleaching with sweet potato extract as an additive: An SEM study

The aim of this in vitro study was to evaluate the marginal integrity of an alkasite restoration in comparison to that of a conventional composite resin restoration following intra-coronal bleaching with 30% hydrogen peroxide (HP) containing sweet potato extract (SPE) as an additive. Access cavities were prepared in 60 extracted human incisors. The teeth were decoronated 2mm below the CEJ and the pulp chambers were sealed cervically. The samples were divided into two groups (n = 30) based on the type of restorative material - group I: Hybrid composite resin and group II: Alkasite restorative material. Both the groups were divided into three subgroups (n = 10) based on the intra-coronal bleaching agent used namely, subgroup A: no bleaching (NB); subgroup B: 30% hydrogen peroxide (HP) and subgroup C: 30% hydrogen peroxide containing SPE (HSP). The tooth-restorative interface was observed under a scanning electron microscope (SEM) to determine the marginal integrity. The results were tabulated and statistically analyzed using one-way ANOVA. Specimens bleached with HP alone showed higher marginal gaps, irrespective of the restorative material used. Subgroups A and C showed lesser marginal gaps under both the restorative materials. An improved marginal integrity was seen with the alkasite material. It can be concluded that the addition of SPE to HP improves the marginal integrity of the coronal restorative material placed immediately post-bleaching. The new alkasite material holds promise as a permanent coronal seal in cases of intra-coronal bleaching.

In vitro and in silico evaluations of resin-based dental restorative material toxicity

OBJECTIVES

This study aims to evaluate the cytocompatibility of three provisional restoration materials and predict neurotoxic potential of their monomers. These materials are Tab 2000® (methyl methacrylate based), ProTemp 4™ (bis-acrylic based) and Structur 3® (urethane dimethacrylate based).

MATERIALS AND METHODS

Resin samples were incubated in a cell culture medium and the cytotoxic effects of these extracts were studied in 3T3 fibroblast cells through MTT and crystal violet assays as well as ROS assessment. The presence of relevant leached monomers was determined by HPLC. Additionally, the blood-brain barrier (BBB) permeability to these resin-based monomers was predicted using ACD/Labs algorithms model.

RESULTS

Cell survival rates were compared with the resin extracts, and Structur 3® was statistically significant different from the others (p < 0.001) at all-time incubation periods. All materials induced a dose-dependent loss of cell viability; however, only Structur 3 extracts were cytotoxic against 3T3 fibroblasts. The highest cytotoxic effect (77%, p < 0.001) was observed at 24 h incubation period, which may be associated with the presence of urethane dimethacrylate (UDMA) leached monomers. Furthermore, the computational model showed that most monomers under study are expectedly capable of crossing the BBB.

CONCLUSIONS

Our results showed that Structur 3® is not cytocompatible with our cell model and UDMA is a potential neurotoxic compound.

CLINICAL RELEVANCE

These results indicate that only ProTemp 4™ and Tab 2000® are safe for provisional restorations.

Shear bond strength and adhesive remnant index of orthodontic brackets bonded to enamel using adhesive systems mixed with TiO2 nanoparticles

INTRODUCTION

It is recently suggested that titanium dioxide (TiO2) nanoparticles can be added to bracket luting agents in order to reduce bacterial activity and protect the enamel. However, it is not known if this addition can affect the shear bond strength (SBS) below clinically acceptable levels. Therefore, this study examined this matter within a comprehensive setup.

METHODS

This in vitro experimental study was conducted on 120 extracted human premolars randomly divided into four groups (n=30): in groups 1 and 2, Transbond XT light-cured composite with or without TiO2 was applied on bracket base; in groups 3 and 4, Resilience light-cured composite with or without TiO2 was used. Brackets were bonded to teeth. Specimens in each group (n=30) were divided into three subgroups of 10 each; then incubated at 37°C for one day, one month, or three months. The SBS and adhesive remnant index (ARI) were calculated and compared statistically within groups.

RESULTS

The SBS was not significantly different at one day, one month or three months (p>0.05) but composites without TiO2 had a significantly higher mean SBS than composites containing TiO2 (p<0.001). The SBS of Transbond XT was significantly higher than that of Resilience (p<0.001). No significant differences were noted in ARI scores based on the type of composite or addition of TiO2 (p>0.05).

CONCLUSIONS

Addition of TiO2 nanoparticles to Transbond XT decreased its SBS to the level of SBS of Resilience without TiO2; thus, TiO2 nanoparticles may be added to Transbond XT composite for use in the clinical setting.

Titanium Oxide (TiO₂)/Polymethylmethacrylate (PMMA) Denture Base Nanocomposites: Mechanical, Viscoelastic and Antibacterial Behavior

Currently, polymethylmethacrylate (PMMA) is the most popular denture base material. Most fractures of dentures that occur during function are due to its insufficient mechanical strength. The major drawbacks of PMMA are insufficient ductility, strength, and viscoelastic behavior. The purpose of this study was to evaluate a polymethylmethacrylate denture base material modified with TiO₂ nanoparticles in terms of nanomechanical, creep-recovery, and relaxation. Additionally, the effects of addition TiO₂ nanoparticles on the thermal and antimicrobial adhesion behaviors were investigated. Differential scanning calorimetry and thermogravimetric analysis indicated that the effect of small amounts of TiO₂ nanoparticles (1 wt. %, 2 wt. %, and 3 wt. %) on the degradation behavior of PMMA denture bases was insignificant. The nanomechanical test results of the PMMA and PMMA/TiO₂ nanocomposites indicated that the hardness and modulus in the nanoscale range improved due to TiO₂ addition. At a 1200-nm penetration depth, the modulus increased by 10%, 16%, and 29% and hardness increased by 18%, 24%, and 35% with the addition of 1 wt. %, 2 wt. %, and 3 wt. % TiO₂, respectively. Furthermore, the creep-recovery and relaxation behaviors of PMMA were significantly improved due to the addition of TiO₂. The creep strain decreased from 1.41% to 1.06%, 0.66%, and 0.49% with the addition of 1 wt. %, 2 wt. %, and 3 wt. % TiO₂, respectively. The relaxation test results showed that the initial stress under 1% strain improved to 19.9, 21.2, and 22 MPa with the addition of 1 wt. %, 2 wt. %, and 3 wt. % TiO₂, respectively. The improvement in the nanohardness, modulus, creep recovery, and relaxation behavior of PMMA due to the addition of TiO₂ nanoparticles indicated the role of the nanoparticles in increasing the PMMA matrix stiffness by reducing its mobility and free volume. TiO₂ nanoparticles also improved the antimicrobial behavior of PMMA by significantly reducing bacterial adherence with increasing TiO₂ ratio.

Cytotoxicity and proinflammatory cytokine expression induced by interim resin materials in primary cultured human dental pulp cells

STATEMENT OF PROBLEM

Acrylic resin materials for interim restoration may adversely affect pulp tissue during the polymerization phase.

PURPOSE

The purpose of this in vitro study was to determine the cytotoxic and proinflammatory cytokine production effects induced by interim resin materials in primary cultured human dental pulp cells (hDPCs).

MATERIAL AND METHODS

Five interim resin materials were evaluated: 3 types of chemically activated products, 1 light-activated product, and 1 computer-aided design and computer-aided manufacturing (CAD-CAM) product. After obtaining eluates from interim resin materials that either were in the process of polymerizing or were already polymerized, these extracts were cocultured with hDPCs under serially diluted conditions (50%, 25%, 12.5%, 6.25%, and 3.125%) for 24 hours with positive (1% phenol) and negative (distilled water) controls. A cell viability assay with tetrazolium was used to evaluate toxic effects on the cells, and images of both live and dead cells were captured using confocal microscopy. Proinflammatory cytokine levels were measured using cytokine antibody arrays. All experiments were independently repeated 3 times, and data were analyzed using 1-way ANOVA and post hoc Tukey honest significant differences test (α=.05).

RESULTS

Cell viabilities less than 70% were observed from the eluates of the 3 chemically activated products under the 50% conditions. Among the chemically activated products, the adverse effects were significantly greater with eluates derived from the polymerizing phase compared than those that had already polymerized, as shown by confocal microscopy images of live and dead cells. However, the light-activated and CAD-CAM-fabricated products did not adversely affect the hDPCs. Significantly increased levels of proinflammatory cytokines were not detected in 12.5% of extract from polymerizing compared with distilled water control.

CONCLUSIONS

The 50% eluates derived from chemically activated interim resin during the polymerizing phase were cytotoxic to hDPCs and may adversely affect pulp tissue. Recommendations such as excess washing are necessary during fabrication.

Reducing the effect of polymerization shrinkage of temporary fixed dental prostheses by using different materials and fabrication techniques

OBJECTIVE

The aim of this laboratory study was to evaluate the horizontal and vertical effects of the polymerization shrinkage of three-unit temporary fixed dental prostheses (FDPs) on the position of the prepared teeth. In addition, the reduction of these effects by using different fabrication techniques was evaluated.

METHODS

A total of 192 temporary FDPs were fabricated using one methacrylate (MA) and two dimethacrylate (DMA) materials. Each material group (n=64) was divided into two groups according to the fabrication methods (M1: curing on the prepared teeth, M2: curing in a silicone mold). Each fabrication group was divided into four subgroups (n=8) according to the relining method used (B: no relining, S: spacer foil 300μm, DG: grinding-out with 500μm cutting depth, and FG: free grinding). The experimental apparatus consisted of two abutment teeth lowered at right angles into a silicone mold. One prepared tooth was embedded in silicone to simulate the periodontium and permit slight horizontal tooth movement. The dimensional changes were recorded with an optical microscope. The test images were superimposed and measured using image analysis software.

RESULTS

The statistical analysis showed that there were significantly higher horizontal changes for the MA than the DMA resins in M1, while there was none in M2. Regarding the vertical changes, there were significant differences between the baseline group and all relining and fabrication groups in all materials.

SIGNIFICANCE

Relining of directly fabricated temporary FDPs significantly reduces the effect of polymerization shrinkage and thus secures the position of the prepared teeth.